I 


4 


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in  2016 


https://archive.org/details/anatomyofhumanbo41  bell 


THE 


ANATOMY 

OF  THE 

HUMAN  BODY. 


IN  FOUR  VOLUMES, 

ILLUSTRATED  WITH  ONKHUNDRED  AND  TWENTY-FIVE  ENGRAVINGS. 


VOLUME  IV. 

CONTAINING  THE 

ANATOMY  OF  THE  VISCERA  OF  THE  ABDOMEN \ 
THE  PARTS  IN  THE  MALE  AND  FEMALE  PEL- 
VIS., AND  THE  LYMPHATIC  SYSTEM. 

PART  I. 

OF  THE  ABDOMINAL  VISCERA. 

INTRODUCTORY  VIEW  OF  THE  SYSTEM  OF  THE  VISCERA, 
AND  OF  THE  STRUCTURE  OF  GLANDS. 

Chap.  i. — Of  the  Stomach  and  Intestines Chap.  zi. — Of  the  Liver,  Spleer, 

Pancreas,  and  Kidney. 

PART  II. 

OF  THE  MALE  PARTS  OF  GENERATION. 

Chap.  i. — Of  the  Parts  within  the  Pelvis- Chap,  ii — Of  the  Parts  connected 

with  the  Viscera  of  the  Pelvis,  but  situated  without  it. 

PART  III. 

OF  THE  PARTS  OF  THE  FEMALE  PELVIS. 
PART  IV. 

OF  THE  LYMPHATIC  SYSTEM, 
an  ^ppentriju 
By  CHARLES  BELL , 

FELLOW  OF  THE  ROYAL  COLLEGE  OF  SURGEONS  OF  EDINBURGH. 

NEW- YORK  : 

PRINTED  AND  SOLD  BY  COLLINS  AND  CO.  NO.  1 89. 
PEARL-STREET. 

1 812. 


CONTENTS. 


—4—— 

VOL.  IV. 


PART  I. 

OF  THE  ABDOMINAL  VISCERA. 


r 

INTRODUCTORY  VIEW  OF  THE  SYSTEM  OF  THE 
VISCERA,  AND  OF  THE  STRUCTURE  OF  GLANDS, 
Page  1. 


CHAP.  I. 

Of  the  Abdomen  in  general,  and  of  the  Peritoneum, 


Page 

17 


CHAP.  II. 


Of  the  Membranous  Viscera  of  the  Abdomen, 

Section  1.  Of  the  CEsophagus, 

2.  Of  the  Stomach,  - 

3.  Of  the  small  Intestines, 

4.  Of  the  great  Intestines, 

CHAP.  III. 

Of  the  Solid  or  Glandular  Viscera  of  the  Abdomen, 
Section  1.  Of  the  Liver,  - 

2.  Ot'the  Pancreas,  - - 

3.  Of  the  Spleen,  - 

4.  Of  the  Kidney,  - 


24 

25 
28 
40 
52 


58 

ib. 

76 

79 

84 


»v 


CONTENTS 


PART  II. 


OF  THE  MALE  PARTS  OF  GENERATION. 
CHAP.  I. 

Page 

Of  the  P arts  within  the  Pelvis,  - - 96 

Section  1.  Of  the  Bladder  of  Urine,  - - ib. 

2.  Of  the  Prostate  Gland,  - - 100 

CHAP.  II. 


Of  the  Parts  connected  with  the  Viscera  of  the  Pelvis, 

but  seated  without  it,  ' - - - 101 

Section  1.  Of  the  Penis  and  Urethra,  - - ib. 

2.  Of  the  Testes,  - - - 108 


PART  III. 

OF  THE  FEMALE  PARTS  OF  GENERATION. 
CHAP.  I. 


The  External  Parts  of  Generation,  - 128 

CHAP.  II. 

Of  the  Parts  contained  within  the  Female  Pelvis,  137 

Section  1.  Of  the  Bladder  of  Urine,  - - ib. 

2.  Ot  the  Vagina  ; of  its  Shape,  Connections,  &c.  139 

3.  Of  the  Womb,  - 142 

4.  Of  the  Ovaria,  ...  148 


PART  IV. 

OF  THE  LYMPHATIC  AVD  LACTEAL  SYSTEMS  OF 
VESSELS. 

CHAP.  I. 


Of  the  Lymphatic  and  Lacteal  Systems  of  Vessels, 


179 


CONTENTS, 


V 


Page 


Introductory  Views,  - - * ■*  179 

Section  1.  Of  the  Capillary  Vessels,  - - 180 

2.  Of  the  Lymphatic  System  in  particular,  182 

3.  Of  the  Glands  of  the  Absorbent  System,  183 

4.  Origin  of  the  Lymphatics,  and  of  the  Doc- 

trines of  Absorption,  - - 185 

CHAP.  II. 

Of  the  Course  of  the  Lymphatics,  - - 195 


APPENDIX. 


Containing  the  Description  of  the  Venous  System  and 

the  Anatomy  of  the  Teeth,  - 211 

CHAP.  I. 

Of  the  Veins  in  general,  ....  jb. 

Section  1.  Ofthe  Veins  of  the  Head  and  Neck,  217 

2.  Of  the  Veins  ofthe  Arm,  - - 220 

3.  The  superior  Vena  Cava,  the  Vena  Azygos, 

and  the  lesser  V eins  of  the  Thorax,  223 


CHAP.  II. 

Ofthe  Veins  which  unite  to  form  the  Inferior  Vena  Cava,  225 
Ofthe  Teeth,  ■>  229 


Vol.lV.P/.I. 


P ItuvD  rooming  of  the  Abdomen,  Shouting  the  Inflections  ot  the  Ptntotuum 


Belt  del* 


JLenev  Cc. 


EXPLANATION 


OF  THE 

PLATES. 


PLATE  I. 


This  plate  represents  an  ideal  section  of  the  abdomen,  and 
the  cut  edge  of  the  peritoneum  is  represented  by  the  white  line. 

A.  The  liver. 

B.  The  INTESTINES. 

C.  The  KIDN  : Y. 

D.  The  BLADDi.lt  of  URINE.  - 

E.  The  RECTUM. 

1.  The  peritoneum,  where  it  lines  the  abdominal  muscles. 

2.  The  peritoneum,  where  it  is  reflected  to  form  the  liga- 

ment of  the  In  er. 

3.  The  liver  being  represented  cut  through,  we  can  trace  the 

lamina  ot  the  ligament  2,  over  its  surface  3,  forming 
the  peritoneal  coat  of  this  viscus. 

4.  Marks  the  peritoneum  reflected  from  the  liver  upon  the 

diaphragm. 

5.  Here  the  peritoneum  is  reflected  off  from  the  spine,  to 

form  one  ol  the  lamina  of  the  mesentery. 

6.  The  peritoneal  coat  of  the  intestine,  which  we  can  trace 

round  the  circle  of  the  gut  until  it  unites  again  with  the 
mesentery. 

7.  7.  The  peritoneum,  forming  the  lower  lamina  of  the  me- 

sentery. 

8.  The  p ritoneum  at  that  part  where  it  is  reflected,  and 

covers  the  kidney. 

9.  The  peritoneum  is  here  descending  upon  the  rectum  E, 

we  see  it  reflected  over  the  gut,  and  descending  again 
betwixt  the  rectum  and  bladder. 


vm 


explanation  op  the  plates. 


10.  The  peritoneum  where  it  forms  a coat  to  the  fundus  of 

the  bladder. 

11.  At  this  part  we  see  the  peritoneum  reflected  up  upon  the 

os  pubis,  and  from  that  we  trace  it  to  fig.  1.  Thus  we 
see,  that  the  peritoneum  can  be  traced  round  all  its  vari- 
ous inflections  and  processes  ; which  shews,  that  it 
forms  one  continuous  sac,  and  that  the  intestines  and 
the  liver  are  equally  on  the  outside  of  this  membrane 
with  the  kidney. 


Explanation  of  Plate  II. 

This  Plate  represents  the  epididimis  and  testicle,  injected 
with  quicksilver,  and  dissected. 

A.  The  body  of  the  testicle  with  the  tunica  albuginea  dissect- 

ed off. 

B.  B.  The  seminal  vessels  in  the  body  of  the  testicle,  or  tu- 

buli  testis.* 

C.  The  rete  testis  formed  by  the  union  of  the  vessels  B. 

B. 

D.  The  vasa  efferentia,  which  as  they  proceed  from  the 

testicle,  are  convoluted  in  a conical  figure,  and  are  call- 
ed the  VASCULAR  CONKS. 

E E.  The  epididimis  formed  of  the  union  of  the  vascular 
cones  : it  is  a little  dissected  and  spread  out. 
f.  The  vas  deferens. 


Explanation  of  Plate  III. 

This  Plate  represents  the  prostate  gland,  vesiculee  seminales, 
and  lower  part  of  the  bladder,  the  parts  being  previously  har- 
dened in  spirits,  the  vesicuke  were  afterwards  cut  open. 

A A.  The  body  of  the  prostate  gland  ; it  is  that  lower  part 
of  the  gland  which  can  be  felt  through  the  rectum. 

B.  The  prostate  gland  is  here  cut  into  and  dissected,  in  fol- 
lowing the  ducts  of  the  vesiculse. 

* Where  the  tubuli  are  emerging  to  form  the  rete  vafculofum,  or  rete  teftis, 
they  are  called  the  vafa  retta. 


* 


< • 


’ 


* » 


'/;,//  rjr/.: 


IWJK 


P///7.A?  ff/e  *//!//  •/  //; 


_/y  f /?/?//  V,  / 


licit.  'rjrl* 


W.w 


r/w 


Veil.  IV. 


' Pl.v. 


A . Crus  fients 
JJ  Bui 6 of  the  Uret h ret 
C Membranous  fit  of the  Zrrethra 

D.  Prostate  Gtanc? 


E . Vet  se  etc  £ ce  Sem.  t rz 
EE  ~Vasa.  cte/erentia 
G.  E/ie  Ureter 

Jf  Etuctcter  corerect b y tfieEerifoneum 


L crust/  set 


/■>//  - . 


explanation  of  the  PLATES.  ix 

c.  The  extremities  of  the  ducts  common  to  the  vesiculse  semi- 
nales  and  vasa  deferentia. 

E>  D.  The  cells  of  the  vesicuke  serninales,  which  are  laid  open 
by  a section. 

E.  The  left  vas  deferens,  which  is  also  laid  open  to  shew 

the  cellular  structure  which  it  assumes  towards  its  ter- 
mination. 

F.  The  RIGHT  VAS  DEFERENS. 

G G.  The  foramina,  by  which  the  vasa  deferentia  open  into  the 
common  duct. 

H.  The  lower  and  back  part  of  the  bladder. 

I.  The  RIGHT  URETER. 


Explanation  of  Plate  IV. 

This  plate  represents  a section  of  the  neck  of  the  bladder. 

A.  The  lower  part  of  the  urinary  bladder  near  the  neck. 

B.  The  opening  of  the  right  ureter,  which  is  marked  1 fig.  iii. 
a c.  The  substance  of  the  prostate  gland,  which  is  cut  through  ; 

its  thickness,  texture,  and  the  manner  in  which  it  sur- 
rounds the  beginning  of  the  urethra,  will  be  understood 
from  this  plate, 
d.  The  urethra  laid  open. 
f.  The  verumontanum,  or  caput  galinaginis. 

G G.  The  points  ol  feathers  put  into  the  openings  of  the  vesi- 
culse  serninales  and  vasa  deferentia. 

N.  B.  Round  these  ducts,  on  the  surface  of  the  verumon- 
tanum, and  in  that  part  of  the  urethra  which  is  surrounded  by 
the  prostate  gland,  innumerable  mucous  ducts  may  be  observ- 
ed : into  some  of  these  small  bristles  are  introduced. 


Vol.  IV. 


b 


E XP  LANA  TION 


OF  THE 

PLATE  S. 


PLATE  VI. 

Fig.  1. 

An  ovum  in  a verv  early  stage,  representing  the  shaggy 
surlace  of  the  true  chorion. 

Fig.  2. 

We  may  see  here  the  fetus  in  a very  early  stage  contained 
in  the  transparent  amnion,  and,  attached  to  the  outside  of  the 
amnion,  the  vlsicula  umbilicalis. 

N.  B.  These  are  not  representations  of  the  same  abortion. 

Fig.  3. 

Represents  the  ovum  a little  more  advanced. 

A.  The  Chorion. 

B.  The  Amnion. 

c.  The  Fcetus  hung  by  the  Umbilical  Chord. 


Explanation  of  Plate  VII. 

This  plate  represents  two  views  of  a conception,  we  shall 
say  about  the  end  of  the  first  month,  and  here  the  decidua  and 
the  ovum  have  been  thrown  off  together.  This  abortion  was 
prepared  so  as  to  resemble  the  beautiful  engravings  in  Dr. 
Hunter’s  xxxiv  table. 


JSellTde?! 


Vol . IV. 


Kg,  a. 


JEVirfe.  VR; 


■ C 


-L.  s-s>,<ry  b»v~  / 


explanation  of  the  plates.  xi 

Fig.  l. 

The  deciduous  efflorescence  formed  by  the  womb  is  seen 
here  entire,  and  seen  as  if  moulded  to  the  cavity  of  the  womb  : 
it  is  only  necessary  to  observe  that  it  hung  inverted. 

A.  The  lower  part  of  the  conception,  which  was  near  the 

neck  of  the  womb,  and  which  has  some  coagula  of 
blood  attached  to  it. 

B.  B.  Quills  introduced  within  the  decidua  by  an  opening  near 

the  neck  of  the  womb,  and  their  points  brought  out  at 
that  part  of  the  membrane  which  answers  to  the  ope 
ing  of  the  Fallopian  tubes  : there  it  is  either  en'th _ 
deficient,  or  it  is  so  thin  that  it  has  been  torn  at  c.  c. 

Fig.  2. 

Here  the  other  side  of  the  conception  is  shewn,  and  the 
ovum  is  seen  to  have  adhered  to  the  outer  surface  of  the 
decidua. 

aa.^-ST  The  quills  introduced  into  the  cavity  of  the  decidua. 
B.  The  shaggy  surface  of  the  decidua, 
c.  c.  The  fleecy  o&tr  surface  of  the  chorion. 

It  is  here  to  be  observed  that  the  ovum,  c d e.  may  be  sup- 
posed to  be  as  it  has  descended  from  the  ovarium,  only  some- 
what enlarged,  and  it  is  here  evidently  on  the  outside  of  the 
decidua,  but  it  has  been  torn  open,  and  that  deciduous  surface 
which  connected  it  to  the  surface  of  the  womb  at  this  place  has 
been  left  with  the  womb,  to  be  afterwards  thrown  off  with  the 
discharges. 

D.  The  delicate  membrane  the  amnios. 

E.  The  umbilical  chord,  and  part  of  the  foetus. 


Explanation  of  Plate  VIII. 

This  and  the  following  plate  represents  a conception 
third  month,  and  as  the  abortion  was  thrown  off  very 
we  have  another  opportunity  of  observing  the  state 
decidua  in  a more  advanced  state. 

a.  A thread  passed  through  the  more  solid  placentary  mass 

suspending  the  whole. 

b.  B.  The  decidua,  having  a peculiar  reticulated  appearance. 

c.  c.  Shreds  of  the  decidua,  where  it  has  burst  in  the  de- 

livery. 


of  the 
entire, 
of  the 


XU 


explanation  op  the  plates. 


d.  The  decidua  REFLrxA,  through  which  also  the  proper 
membranes  have  burst. 

E.  The  TRUK  CHORION. 

p.  Very  small  curling  arteries  which  are  entering  the  decidua, 
or  what  may  be  considered  as  the  maternal  portion  of 
the  placenta. 


Explanation  of  Plate  IX. 

We  have  here  presented  a view  of  a section  of  the  same 
conception. 

A.  The  DECIDUA. 

B.  b.  The  cut  edge  of  the  decidua,  which  will  be  seen  to 

surround  the  whole  ovum,  and  particularly  it  may  be 
observed  to  form  on  the  upper  part  a distinct  lamina 
from  the  placenta  f. 
e.  c.  The  decidua 
d.  The  decidua  REFLEXA. 

p.  ThepLAC.NTA  already  formed  by  the  accumulated  vessels 
of  the  chorion. 

G.  The  chorion  towards  the  lower  part  of  the  womb  ; here, 
it  may  be  observed  the  fleecy  vessels  have  disappeared. 
h.  The  AMNION. 

t.  The  umbilical  chord  twisted  three  times  around  the  neck 
of  the  fcetus. 


'OTgr  Q sut/joj  .ty  tytysTjg&j- 

■ . ■ 


* 1 / /.> 


INTRODUCTION* 


VIEW  OF  THE  SYSTEM  OF  THE  VISCERA,  AND  OF  THE 
STRUCTURE  OF  GLANDS. 

In  this  last  volume  we  have  to  comprehend  the  anatomy  and 
functions  of  the  several  viscera  of  the  abdomen  and  pelvis,  con- 
sidered  not  only  as  individual  parts,  but  as  connected  together 
and  as  forming  with  the  lymphatic  and  circulating  systems  of 
vessels  a great  part  of  that  chain  of  mutual  dependence  and 
relation  which  constitutes  the  animal  ceconomy  a whole.  It 
becomes  necessary  therefore  to  take  here  a slight  and  cursory 
view  of  the  ceconomy  of  the  intestinal  canal  and  absorbing  sys- 
tem, including  at  the  same  time  something  of  the  history  of 
opinions  regarding  secretion  and  the  structure  of  glands.  It 
will  be  understood,  that  these  introductory  observations  are 
meant  only  to  combine  the  several  parts,  and  to  prevent  that 
manner  of  description,  which  is  necessary  to  accuracy  and  mi- 
nuteness, from  leading  us  to  consider  the  several  parts  as  dis- 
tinct and  insulated. 

An  animal  body  is  never  for  a moment  stationary  : the  re- 
motest part  is  in  action,  and  every  point  is  suffering  a perpetu- 
al change.  From  the  first  moment  of  our  existence  we  have 
commenced  a revolution  : we,  by  slow  degrees,  advance  in  ac- 
tivity and  strength,  and  ripen  to  maturity  ; but  by  a slow  and 
as  sure  gradations  we  decline  to  feebleness  and  infirmities  ; and 
the  more  rapidly  that  animals  advance  in  the  first  stage  of  their 
progress,  so  is  the  proportion  of  their  decline. 

But  it  is  not  in  observing  the  changes  of  the  animal  body 
from  youth  to  age  that  the  operations  of  the  ceconomy  are  the 
most  interesting.  It  is  when  we  find  the  living  body  to  con- 
sist of  parts  performing  a variety  of  functions,  and  these  con- 
nected and  mutually  dependent ; when  we  see  the  circulating 
fluid  throwing  out  fluid  and  solid  secretions  to  build  up  and 
support  the  body,  which  is  in  incessant  and  daily  decay.= 
Vol.  IV.  A 


.2 


INTRODUCTION. 


Again,  our  admiration  is  strongly  excited  when  we  observe  the 
system  to  consist  of  fluids  and  solids,  and  the  existence  of  the 
animal  to  depend  upon  the  balance  of  their  power  ; the  fluids 
separating  and  combining  in  new  affinities,  and  forming  the 
various  secretions  ; and  the  solids  having  action,  and  that  ac- 
tion controlling  the  affinities  and  new  combinations  of  the  cir- 
culating fluids.  We  find  that  life  subsists  by  the  due  action  of 
solids  and  fluids  ; or  that  an  incomprehensible  influence  in  a 
living  body  is  exerted  on  the  latter,  and  that  the  chemist  can 
never  so  combine  the  fluids  out  of  the  body  as  to  imitate  the 
changes  produced  in  a living  system  of  fluids  and  vessels— 
Forgetting  that  animation  is  the  essential  character  of  living 
bodies,  physiologists  have  too  much  endeavoured  in  every  age 
to  explain  the  phenomena  of  animated  nature  by  illustrations 
drawn  from  mechanics,  chemistry,  or  hydraulics. 

In  a body  in  which  there  is  life  there  is  a perpetual  waste  ; 
first  by  secretions,  which  for  particular  purposes  are  thrown 
into  the  cavities  and  afterwards  carried  out  of  the  body  en- 
tirely by  the  excretions  of  the  kidney,  the  perspiration  by  the 
surface,  the  exhalation  by  the  lungs,  the  secretions  of  the  inter- 
nal cavities  as  of  the  intestines.  But  more  than  this,  there  is 
a decomposition  of  the  solids  of  the  body  which  are  carried  in- 
to the  circulating  fluids,  and  finally  dismissed  from  the  sys- 
tem. Lastly,  we  cannot  but  observe,  that  even  the  powers  of 
muscular  motion,  nay,  the  powers  of  the  mind  and  of  the  sen- 
ses, are  exhausted  by  exercise,  and  renovated  through  the  in- 
fluence of  the  circulation.  The  continued  action  of  a muscle 
is  followed  by  feebleness,  and  the  continued  impression  of  the 
rays  of  light  exhausts  the  retina,  so  that  the  object  becomes 
first  faint  and  then  vanishes. 

Since  there  is  waste  of  the  solids  and  fluids,  and  exhaustion, 
of  the  energies  of  the  system,  so  also  must  there  be  a source  of 
supply  and  means  of  renovating  its  action.  Accordingly  ani- 
mals have  appetites  requiring  the  supply  of  food,  and  the  call 
of  hunger  is  controlled  by  the  necessities  of  their  svstem. — 
When  food  is  received  into  the  first  passages,  there  is  thrown 
out  from  the  stomach  a fluid,  which  dissolves  it,  changes  its 
properties,  and  is  itself  essentially  altered.  The  work  of  assi- 
milation is  thus  begun.  As  this  converted  fluid  takes  its  course 
through  the  intestines,  it  is  more  and  more  changed  ; more 
assimilated  to  the  nature  of  the  peculiar  fluids  of  the  animal  ; 
and  having  still  additional  secretions  united  to  it,  particularly 
the  bile,  it  is  by  these  means  separated  from  the  grosser  parts 
of  the  aliment.  This  fluid,  which  is  now  called  chyle,  is  ab- 
sorbed by  a particular  and  appropriate  system  of  vessels, 
which,  from  their  conveying  this  white  and  milky-like  fluid. 


INTRODUCTION. 


3 


are  called  the  lacteals.  These  lacteal  vessels  carry  the  chyle  to 
the  thoracic  duct,  the  trunk  of  the  absorbing  system  ; but  not 
directly  ; for  the  chyle  is  deposited  in  the  mesenteric  glands, 
from  which  it  is  again  absorbed  and  carried  forward.  Or  if 
we  suppose  these  glands  to  be  merely  convoluted  vessels,  its 
-How  is  at  least  delayed,  so  that  it  is  not  at  once  thrown  into  the 
mass  of  circulating  fluids. 

We  find  then  that  the  stomach  performs  digestion,  and  the 
spleen,  we  will  venture  to  affirm,  is  subservient  to  it.  The 
secretion  of  the  liver  we  find  to  prepare  the  chyle  for  absorp- 
tion, while  at  the  same  time  it  is  the  peculiar  stimulus  to  the 
intestines.  The  pancreas  pours  out  a fluid  which  tempers  the 
acrid  bile.  The  superior  part  of  the  intestinal  canal  absorbs 
the  nutritious  fluid  or  chyle,  while  the  gross  remains  of  the 
food  move  on  to  be  deposited  in  the  great  intestines.  The 
great  intestines  are  not  only  receptacles,  but  form  at  the  same 
time  an  extensive  secreting  surface  useful  in  the  (Economy,  by 
throwing  off-  the  waste  of  the  system. 

The  lacteal  vessels,  which  take  up  the  chyle,  are  but  branch- 
es of  the  system  of  absorbents — which  is  a system  consisting  of 
two  great  divisions,  the  lacteals  and  lymphatics  : the  first  re- 
ceiving the  nutritious  fluids  from  the  intestinal  canal,  and  the 
latter  being  absorbents,  taking  up  the  fluids  which  have  been 
thrown  out  upon  the  cavities,  and  surfaces  of  the  body;  and 
we  presume  upon  the  solid  parts  of  the  body  also.  Thus  the 
new ’fluids,  rich  in  supplies,  are  mingled  with  those  which  are 
fraught  with  the  waste  and  decomposition  of  the  system. — The 
thoracic  duct,  the  trunk  of  this  system,  conveys  these  fluids 
thus  mingled  together  into  the  right  side  of  the  heart,  where 
they  are  received  into  the  vortex  of  the  circulating  red  blood. 
These  fluids,  now  agitated  and  wrought  up  with  the  blood  in 
the  cavities  of  the  heart,  are  sent  through  the  circulation  of  the 
lungs,  and  submitted  to  the  influence  of  their  action  and  the  ex- 
posure to  the  atmospheric  air. 

When  chyle  is  formed  in  the  stomach  and  intestines,  it  is 
observed  to  consist  of  albumen,  serum,  globules,  and  salts  : 
but  the  change  which  it  may  undergo  by  its  reception  into  the 
lacteals,  its  being  deposited  in  their  glands,  its  mingling  with 
the  lymph,  its  agitation  in  the  heart,  have  not  been  observed, 
though  it  is  natural  to  suppose  that  by  degrees  it  assimilates  in 
its  nature  to  that  of  the  circulating  blood,  and  does  at  last  be- 
come perfectly  similar  by  the  operation  of  the  lungs. 

By  the  exposure  of  the  circulating  fluids  to  the  atmosphere 
in  the  lungs  a gas  is  absorbed,  which  becomes  an  active  prin- 
ciple in  the  blood,  and  from  the  blood  is  communicated  to  the 
solids. 


4 


INTRODUCTION. 


That  the  blood  of  an  animal  has  properties  which  distinguish 
it  from  mere  matter  we  readily  allow  ; but  to  say  that  it  pos- 
sesses life  is  to  use  a term  in  which  few  will  acquiesce.  It 
possesses  properties  while  circulating  in  the  vessels  distinct 
from  those  which  it  shews  out  of  the  body  ; and  these  do  not 
depend  on  the  agitation  and  incessant  motion,  nor  on  the  de- 
gree of  heat,  nor  on  any  similar  circumstance,  but  apparently 
on  some  secret  influence  which  the  vessels  exert  over  it.  The 
analysis  of  the  blood  by  the  chemists  holds  out  to  us  little  hope 
of  advancing  in  the  knowledge  of  the  ceconomy  of  a living  ani- 
mal. Chemistry,  when  applied  to  the  analysis  of  animal 
matter,  leaves  its  devotees  in  a perplexity  of  knowledge 
and  discoveries  which  have  no  end,  and  which  point  to  no  con- 
clusion. 

There  are  produced  from  the  blood  a variety  of  fluids  by  or- 
gans which  are  called  glands,  and  the  formation  or  separation 
of  these  fluids  is  secretion.  But  the  solid  parts  of  the  body 
ought  to  be  considered  as  secretions  equally  with  the  matter 
which  flows  from  the  ducts  of  glands.  For  there  is  formed 
and  deposited  from  the  blood,  during  the  round  of  its  circula- 
tion, bone  to  support  the  incumbent  weight  of  the  body  ; mus- 
cular fibre,  to  give  it  motion  ; as  well  as  all  the  other  variety 
of  solids  and  fluids.  The  only  difference  betwixt  these  solid 
depositions  from  the  blood  and  the  glandular  secretions  is,  that 
the  former  are  still  within  the  influence  of  the  vascular  system, 
and  that  they  are  decomposed  and  re-absorbed,  conveyed  again 
into  the  mass  of  circulating  fluids  before  they  can  be  finally  ex- 
pelled from  the  body. 

The  chemists  have  observed  the  division  of  animal  bodies 
into  solids  and  fluids,  but  the  subdivisions  of  these  are  very  in- 
accurate. The  fluids  they  have  distinguished  into  three  class- 
es ; 1st,  Recrementitious  humours,  which  go  to  nourish  and 
support  the  body  : 2dly,  The  excrementitious  fluids,  which 
are  carried  out  cf  the  body  by  certain  emunctuaries  ; and  the 
Sd  are  of  a compound  nature,  being  partly  recrementitious  and 
partly  excrementitious.  We  must  observe,  however,  that  the 
fluids  enumerated  under  these  heads  shew  it  to  be  a very  inT 
correct  arrangement.  The  first  division  comprehends  the  fat, 
the  marrow,  the  matter  of  internal  perspiration,  and  the  osse- 
ous juice.  The  second  comprehends  the  fluids  of  insensible 
transpiration,  the  sweat,  mucus,  cerumen,  urine,  faeces.  And 
the  last  division  comprehends  the  saliva,  the  tears,  the  bile,  the 
pancreatic  juice,  the  gastric  and  the  intestinal  juice,  the  milk, 
and  the  seminal  fluid.  To  attend  to  their  arrangements  of  the 
golid  parts  of  animals  would  be  equally  far  from  serving  any 
Useful  end  ; for  they  have  throv/n  together  parts  so  discordant 


INTRODUCTION. 


5 


m function  and  so  unlike  in  structure  that  they  can  be  of  no  use 
in  a general  view  of  the  (economy,  and  cannot  in  chemical 
analysis  shew  a uniform  result.* 

Perhaps  all  the  correctness  to  which  we  can  at  present  pre- 
tend is  some  such  division  as  this.  Besides  forming  the  solid 
mass  of  the  animal  body,  these  secretions  are  drawn  from  the 
blood  : fluids  which  are  subservient  to  the  assimilating  of  new 
matter  to  the  system  ; fluids  which  are  useful  in  preserving  the 
mobility  of  parts  ; and,  lastly,  the  secretions  which  convey 
away  the  waste  and  debris  of  the  body,  which  is  successively 
replaced  by  the  opposition  of  new  matter. 

From  this  short  view  of  the  system  we  understand  how  in- 
cessantly the  powers  are  spent  in  action,  and  the  fluids  ex- 
hausted by  deposition  and  secretion,  and  how  essential  to  life 
the  functions  of  those  parts  are  which  act  upon  and  assimilate 
the  food.  It  is  the  consideration  of  these  parts  which  forms 
the  subject  of  the  first  section  of  the  present  volume.  As  in 
the  consideration  of  these  functions  the  structure  of  the 
glandular  organs  becomes  a chief  subject  of  inquiry,  it  will  be 
natural  at  present  to  consider  in  a general  way  the  opinions 
which  have  been  entertained  regarding  the  structure  of  glands. 

The  peculiar  nature  of  that  organization  by  which  the 
several  secretions  are  formed,  has  hitherto  eluded  absolute 
proof  by  experiment  or  dissection.  It  is  imagined  that  there 
are  some  organs  which  do  little  more  than  separate  the  parts  of 
the  blood  like  to  the  exudation  by  exhaling  arteries.  But 
neither  in  the  exhalent  arteries  nor  in  the  simpler  organs  can  I 
imagine  a simple  straining  of  the  blood,  but  rather  that  the 
same  principle  influences  all,  and  that  the  several  varieties  of 
secretion  depend  upon  a modification  of  the  action.  It  would 
appear  that  the  fluids  in  circulation  and  the  vessels  containing 
them  must  reciprocally  affect  each  other : we  know  that  a 
change  on  the  state  of  the  circulating  fluids  will  alter  the  nature 
of  the  glandular  action,  and  an  excitement  of  the  gland  will 
still  more  powerfully  change  the  nature  of  the  secretion  ; the 
active  power  of  the  solids  appearing  to  be  an  agent  which  con- 
trols and  directs  the  chemical  affinities. 

We  are  struck  with  the  variety  of  form  in  the  secreting 
organs.  We  see  a simple  surface  pouring  out  its  fluids  ; or  a 
simple  canal  into  which  the  arteries  throw  out  the  secretion. 
We  find  again  the  secreting  vessels  and  their  ducts  convoluted 
and  massed  together,  forming  proper  glandular  bodies  ; of 
which  kind  are  the  solid  abdominal  viscera. 

When  we  dissect  the  glands  we  do  not  find  them  to  have  a 


Spe  Fourcroy’s  Analyfisof  Animal  Subftances, 


INTRODUCTION. 


6 

similarity  in  structure.  Thus  the  substance  of  the  liver,  the 
kidney,  the  testicle,  &c.  are  quite  unlike,  and  as  their  secre- 
tions are  different  so  are  their  sympathies  : the  effect  of  dis- 
ease upon  them,  and  the  consequences  of  medicine  operating- 
through  the  general  circulation  will  be  to  attach  to  one  indi- 
vidually, leaving  the  others  in  their  accustomed  action. — » 
Glands  are  different  not  only  in  their  outward  form,  their 
general  appearance  when  cut  into,  and  the  manner  of  the  con- 
nection of  their  parts,  but  also  in  a remarkable  manner  in  the 
length,  size,  and  form  of  their  vessels  and  ducts. 

In  considering  the  opinions  of  physiologists  or  anatomists 
regarding  glandular  secretion,  and  the  structure  of  glands,  we 
find  in  the  first  instance  that  the  old  physicians  contented  them- 
selves with  saying  that  the  glands  or  viscera  possessed  a pecu- 
liar power  to  select  and  separate  the  fluids  from  the  blood. 
The  next  class  had  recourse  to  hypothesis  : they  spoke  of  the 
separation  of  certain  parts  by  means  of  fermentation,*  or  by 
a kind  of  filtering  through  the  pores  or  vessels  of  glands  ; that 
these  pores  allowed  only  particles  of  a particular  size  or  figure 
to  pass  them.f  It  was  opposed  to  this  hypothesis,  that  the 
thinner  fluids  must  have  run  through  the  organs  destined  for 
the  grosser  secretions.  But  when  a theory  such  as  this  is  re- 
ceived, no  argument  nor  proof  seems  necessary  to  overthrow  it. 
Resting  upon  authority  alone,  it  stood  until  it  was  overturned 
by  the  fashion  of  new  doctrines  : one  equally  puerile  was  raised 
upon  its  overthrow. 

We  observe,  says  the  founder  of  this  theory,^,  that  wet  or 
oiled  paper  will  only  transmit  fluid  of  that  kind  with  which  it 
is  previously  imbued,  it  will  not  transmit  the  oil  when  wetted, 
nor  will  the  water  make  any  impression  on  the  paper  when  pre- 
viously oiled.  Upon  these  facts  are  to  be  raised  a theory  of 
secretion  ! Betwixt  the  secreting  vessels  and  the  ducts,  in  the 
peculiar  tissue  of  which  glandular  structure  consists,  there  is 
interposed  a fluid  of  that  particular  kind  which  is  required  to 
be  secreted,  and  when  the  blood  is  driven  against  this  tissue  so 
imbued,  no  fluid  but  of  a nature  resembling  that  already  de- 
posited can  be  transmitted.  By  this  hypothesis  they  explained 
secretion,  making  it  to  depend  on  the  attraction  and  repulsion 
of  the  particles  of  the  biood  by  fluids  previously  secreted. 
We  may  surely  leave  this  class  of  physiologists  accounting  for 
the  original  depositation  of  the  fluids  in  the  glands,  without  a 
wish  to  search  with  them  into  the  mystery  of  glandular  secre- 

* Van  Helmont.  Vieuflens,  &c. 
f Charleton,  Defcartes,  Barelli,  Verheyn,  &c.  &c, 

1 Window.  Heivetius. 


INTRODUCTION. 


7 


tion.  Commentators  on  this  -theory,  by  taking  into  the  system 
the  action  of  the  nerves,  indicated  that  they  did  not  altogether 
forget  that  the  body  was  alive.* 

Another  set  of  physiologists  attributed  the  whole  effect  of 
secretion  to  the  velocity  of  the  blood  in  the  glands  or  secreting 
vessels  ;f  others,  to  the  length  and  curves  of  the  vessels,  and 
their  action  upon  the  fluids.  Again,  others  have  been  satisfied 
with  the  round  assertion  that  the  vital  action  was  the  essential 
cause  of  secretion.  This,  it  ought  to  be  understood,  must  be 
universally  acquiesced  in,  while  yet  there  mav  remain  an  in- 
quiry as  to  the  apparent  structure  of  glands.  Disappointed  in 
obtaining  an  unexceptionable  general  theory  of  secretion,  we 
are  only  enabled  to  conclude,  that  while  a power  exists  in  an 
animal  body,  directing  its  actions,  perhaps  both  in  the  solids 
and  fluids,  and  particularly  in  the  mutual  influence  which  they 
exert,  the  form,  length,  and  activity  of  the  vessels  and  ducts 
give  occasion  to  the  greater  or  less  degree  of  intricacy  in  the 
operation  of  the  principles  upon  which  the  secretion  depends. 

Let  us  then  attend  to  the  observations  of  the  strict  anato- 
mists, and  to  the  appearance  which  the  glandular  viscera 
piesent  under  the  knife. 

It  is  not  perfectly  clear  what  the  older  anatomists  meant  by 
the  expression  Parenchyma.  It  would  appear  however  to 
have  saved  them  the  trouble  of  investigation,  and  all  abstruse 
speculation.  They  meant  flesh,  yet  not  muscular  substance, 
but  such  as  the  liver  presents.  This  matter  they  seem  to  have 
conceived  to  be  formed  by  the  blood.  Thus  Highmore  de- 
scribes the  liver  to  be  formed  of  the  blood  of  the  umbilical 
vein  : the  opinion  originally  of  Erasistratus. 

Previous  to  the  time  of  Malpighi  it  is  fruitless  to  trace  the 
opinions  of  anatomists  regarding  the  structure  of  glands. 
He  was  the  first  who  sought  to  throw  light  upon  this  obscure 
subject  by  anatomical  investigation,  and  he  made  a more  rapid 
progress  than  has  been  done  by  any  man  since  his  day.  If  we 
take  into  consideration  the  difficulties  he  had  to  encounter  in  a 
new  field,  and  the  prejudices  of  the  learned  with  which  he  had 
to  combat,  his  merits  will  be  found  greater  than  even  those  of 
Ruysch.  The  opinions  of  Malpighi  were  received  by  those 
who,  forsaking  the  authorities  of  names,  saw  the  importance 
of  the  study  of  anatomy.  Ruysch  himself  gave  credit  to  the 
©pinions  of  Malpighi  in  the  early  part  of  his  life.  But  Ruysch’s 
more  attentive  observations  being  contradictory  to  those 
of  Malpighi,  his  maturer  judgment  rejected  that  anatomist's 

* Conor,  Ten  tamen  epiilolare  de  Secretion^. 

t Boerhaave,  Pitcarne,  &e. 


8 


INTRODUCTION. 


proofs,  and  with  a boldness  in  which  he  was  never  remarkably 
deficient  he  invented  a new  theory,  or  at  least  alleged  new 
facts,  and  swayed  men’s  opinions  with  an  absolute  authority. 

Malpighi  was  an  Italian,  and  born  near  to  Bologna. 
Whilst  yet  a young  man,  being  sunk  under  the  accumulation 
of  family  distress,  absorbed  in  grief,  and  lost  to  the  considera- 
tion of  his  interest,  he  received  comfort  and  assistance  from 
his  master,  who  urged  him  to  embrace  the  medical  profession. 
His  progress  was  rapid.  After  studying  at  Padua,  he  was 
called  to  fill  one  of  the  chairs  in  Bologna.  He  was  then  so- 
licited bv  Ferdinand  II.,  Duke  of  Tuscany,  to  be  professor 
in  the  university  of  Pisa.  Here  he  was  associated  with  liberal 
men  : and  now  only  in  his  second  professorship  did  he  learn 
to  despise  the  scholastic  learning  of  the  time,  and  betook  him- 
self to  experiment  as  the  only  means  by  which  philosophy 
could  be  raised  from  the  oppressive  barbarism  of  the  schools. 
Malpighi  and  Borelli  were  associated  ; they  dissected  to- 
gether ; they  suggested  thoughts  to  each  other  ; they  doubted, 
and  canvassed  freely  each  other’s  opinions  ; and  were  to  each 
other  an  excitement  and  encouragement  to  perseverance  and 
industry.  They  were  supported  by  government ; popular  in 
their  teaching;  while  they . collected  round  them  the  learned 
men  of  the  time.  This  was  the  origin  of  the  famous  Acade- 
my del  Cimento.  Malpighi  was,  after  this,  professor  in 
Messene,  and  died  in  the  Quirinal  palace  at  Rome  of  a stroke 
of  the  apoplexv,*  after  having  been  some  time  physician  to 
Pope  Innocent  XII.  Malpighi  had  many  enemies,  and  even 
some  of  his  colleagues  were  animated  against  him  with  a dis- 
honourable jealous}'.  Many  laughed  at  his  studies  and  occu- 
pations, as  frivolous  and  absurd.  Something  must  be  allowed 
for  men  who  had  laboured  with  diligence  to  become  learned  ; 
for  these  his  opponents,  had  passed  their  lives  in  the  study  of 
the  Arabian  writers.  With  them  studies  were  enforced  which 
held  science  in  subjection  ; studies  which,  in  place  of  invigo- 
rating, served  only  to  chill  and  paralyse  exertion,  and  retard 
ingenious  investigation.  Even  Borelli,  but  from  other  mo- 
tives, opposed  and  censured  some  of  the  dissertations  of  Mal- 
pighi. 

Malpighi  has  been  considered  as  the  inventor  of  this  depart- 
ment of  anatomy,  which  the  French,  curious  in  distinctions, 
have  called  the  analytic  method.  He  shewed  the  impropriety 
of  the  term  Parenchyma,  as  applied  to  the  substance  of 
glands.  He  proved  that  the  lungs,  for  example,  (which  the}' 

* Two  pounds  of  coagulated  blood  were  found  in  the  ventricles  of  his  brain  bjr 


INTRODUCTION. 


also  called  parenchymatous,)  were  not  fleshy,  and  had  no  re- 
semblance to  the  glandular  viscera  of  the  abdomen.  He 
taught,  that  though  glands  are  smooth  on  their  outer  surface, 
they  consist  of  lobules  connected  by  cellular  membrane  : and, 
upon  a still  more  minute  investigation,  that  they  consist  of  in- 
numerable little  follicules  or  sacs  ; that  these  are  interposed  be- 
twixt the  arteries  which  convey  the  fluids  and  the  excretory 
ducts  going  out  from  them  ; that  the  arteries,  or  the  vasa 
afferentia,  after  ramifying  and  encircling  these  bodies,  pierce 
them  and  secrete  the  particular  fluids  into  them.  On  other  oc- 
casions he  describes  these  little  glandular  bodies  as  applied  to 
the  ramifications  of  the  arteries,  like  fruit  hanging  by  the 
branches  of  a tree. 

Malpighi  threw  in  his  liquid  injections  ; dissected  and  ex- 
amined with  the  microscope  ; made  careful  observations  and 
experiments  on  living  animals  ; -and  lastly,  attended  in  a parti- 
cular manner  to  the  phenomena  of  disease.  By  disease  no 
doubt  parts  swell  out  and  are  magnified,  and  become  distinct ; 
but  it  is  not  a test  of  the  natural  structure,  or  implicitly  to  be 
trusted  to. 


Scheme  of  Malpighi' s opinion. 


m 


Fig.  1.  Boerhaave’s  plan  of  Malpighi’s  doctrine,  a a a 
folliculos  glandularum  simplicissimarum  denotat.  h b b sin- 
gularia  emissaria  cuique  utriculo  o,  propria  atque  in  commu- 
nem  canalem  excretorium  d , c,  suos  humores  demittentia  qui 
tandem  per  hujus  aperturam  c,  emittantur. 

Fig.  2.  is  a scheme  farther  to  elucidate  the  opinions  of 
Malpighi.  A,  an  artery  entering  a portion  of  a viscus.  B, 
the  returning  veins.  C,  the  branch  of  communication  betwixt 
the  artery  and  vein  which  serves  to  circulate  the  blood*  and 
convey  a part  into  the  veins.  D,  another  division  of  the 
artery,  which  after  various  plavful  meanderings  terminates  in 
Vol.  IV.  B 


10 


introduction's 


the  follicule  or  little  glandular  bag  E.  F,  the  ducts  which  re- 
ceive the  secreted  fluid  from  the  follicules. 

Ruysch  studied  at  Leyden  under  Van  Horne,  and  at  a 
very  early  age  attached  himself  to  anatomy  and  botany.  At 
this  time  he  brought  himself  into  notice  by  a defence  of  the 
professors  against  one  Bilsius,  who,  although  he  was  learned 
and  acute,  had  attacked  them  with  all  the  weapons  of  a 
Charlatan.  Returning  to  his  native  country,  he  was  raised  to 
the  professorship  of  anatomy  and  botany  in  Amsterdam.  It 
was  here  that  Ruysch  made  those  discoveries  in  anatomy,  and 
that  wonderful  and  sudden  progress  in  practical  anatomy, 
which  not  only  raised  him  above  his  cotemporaries,  but  has 
been  the  admiration  of  all  since  his  time.  Though  new  and 
Various  methods  of  preparing  the  body  have  been  discovered 
since  the  time  of  Ruysch,  yet  there  has  been  no  approach  to 
the  elegance  with  which  he  displayed  the  structure  of  minute 
parts.  It  has  been  said  that,  \vhile  others  preserved  the  hor- 
rid features  of  death,  Ruysch  preserved  the  human  body  in 
the  softness  and  freshness  of  life,  even  to  the  expression  of  the 
features.  We  must  no  doubt  ascribe  some  part  of  this  en- 
comium to  the  exaggeration  naturally  arising  from  the  novelty 
of  the  thing.  But  as  to  his  superiority  in  the  manner  of  dis- 
playing the  minute  vessels  of  delicate  parts,  and  his  methods 
of  preserving  the  parts  in  liquors,  transparent  and  soft  and  so 
as  to  float  in  their  natural  folds,  there  can  be  no  doubt. — 
Neither  can  the  minuteness  and  success  of  his  injections  be 
denied  : we  have  too  many  occasions  in  which  we  must  resort 
to  the  catalogue  of  Ruysch’s  museum  for  the  true  anatomy,  to 
doubt  his  great  success,  or  to  question  the  truth  of  those  en- 
comiums which  have  been  bestowed  upon  him. 

Kings,  princes,  ambassadors,  and  great  generals,  but  more 
than  these,  all  the  learned  men  of  the  time,  crouded  to  the 
museum  of  Ruysch.  W e must  not  blame  him  if,  whilst 
others  were  merely  speculating  about  the  structure  of  parts,  he, 
surrounded  by  so  princely  a museum,  should  simply  have  laid 
open  his  cabinets,  and  bid  them  satisfy  themselves  whether  or 
not  he  was  right.  Ruysch’s  preparations  went  to  contradict 
the  opinions  ol  Malpighi.  His  injections,  pushed  more 
minutely,  showed  those  round  bodies  which  are  to  be  seen  in 
some  of  the  glandular  viscera  (and  which  Malpighi  took  to  be 
little  bags  into  which  the  secreted  fluid  was  poured)  to  be 
merely  convoluted  arteries.  Ruysch  taught,  that  the  minute 
arteries  after  making  these  convolutions  terminated  in  the  be- 
ginning of  excretory  ducts  ; that  there  was  no  substance  or 
apparatus  interposed,  but  that  the  vessels  and  ducts  were  con- 
tinuous. His  opinions  being  formed  upon  the  strength  of 


INTRODUCTION. 


11 


more  minute  preparations,  and  a superior  dexterity  of  anato- 
mical investigation,  few  anatomists  chose  to  be  outdone,  or  to 
acknowledge  that  they  could  not  see  what  he  saw.  This  I 
believe  to  be  one  reason  of  the  rapid  progress  of  Ruysch’s 
opinions. 

Scheme  of  RuyscK’s  opinion. 


r i 


3 3 


1 1 The  smaller  arteries  which  do  not  enter  into  follicules, 
but  are  convoluted.  2 2 The  appearance  of  bodies  or  bags, 
but  which  are  merely  owing  to  the  convolutions  and  tortuous 
figure  of  the  arteries  before  they  terminate  in  the  excretory 
ducts.  3 3 Excretory  ducts  or  vessels  formed  by  the  continued 
extreme  branches  of  the  arteries.* 

The  opinions  of  Malpighi  and  Ruysch  have  held  the  schools 
in  perpetual  controversy  ; most  anatomists  however  leaning  to 
the  authority  of  Ruysch.  There  follows  these  a crowd  of 
French  academicians,  who,  with  Boerhaave,  may  be  con- 
sidered as  mere  commentators  on  the  original  authorities  of 
Malpighi  and  Ruysch.  Some  of  these  argue  for  secretion  by 
continuous  vessels,  and  contend  that  the  arteries  terminate  in 
the  excretory  ducts  ; others,  that  the  secretions  are  made  into 
follicules  ; and  some,  as  Boerhaave,  insist  that  both  are  right 
in  their  observations,  and  in  the  proofs  which  they  have 
adduced,  that  secretion  is  in  part  performed  by  continuous 
vessels,  partly  by  a more  intricate  glandular  apparatus. 

* Ruyfch’s  dodlrine  again  was  thus  opposed  : Ruyfchius  auget  arte  fua  replendi 
extenfionem  vaforum  ultra  naturalem  magnitudinem.  Ruyfchius  arte  fua  deftruit 
glandulas  ; dein  negat.  Ruyfchius  negat  omnes  glandulas.  Melius  ell  & tutius 
omnia  haec  demonftrare  in  cadavere  recenti.’’  F.  Ruyfch  Epift.  ad  Vir.  Clar.  Her, 
Boerhaave,  p.  50. 

It  may  be  farther  obferved,  that  it  was  not  in  the  mere  fa<5t  of  there  being 
follicules,  in  which  Malpighi  and  Ruyfch  differed ; for  the  latter  conceded  that  there 
were  hollow  membranes,  but  contended  that  thefe  were  not  glands.  Their  dif- 
ference of  opinion  is  expreffed  in  the  following  words  of  Ruyfch  : “ Adeoque  dif- 
crepantia  inter  magnum  ilium  virum  et  inter  me  eft,  quod  ille  putat  humores 
delabi  in  glandulas  didtas  fimpliciffimas,— ibi  foveri,  mutari  : Ego  puto,  quod 
arterias  ultimo  fuccos  faciant,  & fadtos  ibi  deponant,” 


12 


INTRODUCTION. 


As  the  forms  of  the  parts  which  throw  out  secretions  have 
an  infinite  variety,  it  may  be  useful  in  this  introductory  view 
to  point  out  these  varieties,  and  their  appropriate  names  * * * § In 
the  first  place,  although  in  general  language  the  term  gland  im- 
plies a secreting  body,  yet  this  does  not  follow  from  the  defini- 
tion of  that  word.  According  to  Hippocrates,  it  is  a tumid 
round  body,  soft,  smooth,  and  shining.  Many  such  bodies, 
and  which  we  call  glands,  have  no  excretory  ducts,  and  do  not 
secrete  a fluid  ; while  most  secreting  parts  admit  of  no  such 
definition.  When,  again,  we  admit  the  definition  of  authors 
who  have  taught  their  peculiar  opinions  regarding  their  struc- 
ture, we  have  a still  less  admissible  description.  Thus  Mal- 
pighi defined  a simple  gland  to  be  “Membrana  cava  cum 
emissario  and  Ruysch  says,  “ Glandulse  nulla  compo- 
nuntur  ex  sola  membrana  cava  cum  emissario,  sed  praecipue 
ex  vasis.” 

These  definitions  of  glands  being  optional  and  uncertain,  it 
is  necessary  to  use  names  appropriated  to  the  several  varieties 
of  form  in  secreting  parts.  Indeed  the  term  gland  is  inadmis- 
sible as  conveying  any  knowledge  of  the  minute  parts  of  which 
the  viscera  are  composed. 

We  must  observe,  however,  that  there  is  a division  of  glands 
still  in  use  into  conglobate  and  conglomerate.  The  first  implies 
a gland  simple  in  its  form,  the  latter  a gland  having  the  ap- 
pearance of  an  assemblage  of  several  glands.f  Now  there  is 
no  gland  that  has  not  more  or  less  the  appearance  which  is  des- 
cribed by  conglomerated  ; that  is,  consisting  of  several  parts, 
united  by  cellular  membrane  : and  the  distinction  is  attended 
with  no  advantage. 

Acini  form  the  last  sub-division  which  we  observe  in  the  vis- 
cera, as  in  the  liver  ; they  are  round  bodies,  not  regularly  in- 
vested with  membranes,  and  which  can  be  teased  out  into  par- 
cels of  minute  vessels.^ 

Cryptce  are  numerous  in  the  body.  We  have  an  example 
of  them  in  the  great  intestines.^  Crypta  is  a soft  body,  con- 

• The  terms  acini,  cotulae,  crypt®,  folliculi,  glandul®,  lacunae,  loculi,  utriculi, 
have  been  almoft  promifcuoufly  ufed ; being  fo  many  names  for  bundles,  bags, 
bottles,  holes,  and  partitions. 

f As  the  falivary  glands  and  the  pancreas.  Farther,  the  lymphatic  glands  are 
generally  called  conglobate  glands,  being  fmooth  and  apparently  fimple  in  their 
flrudture  ; but  thefe,  when  injected,  take  exactly  the  appearance  which  lhould  na- 
turally' be  defcribed  by  the  term  conglomerate,  confifting  of  many  little  cavities. — 
Thefe  lymphatic  glands,  belonging  to  a diftindt  fyftem,  require  no  farther  particu- 
lar definition  to  diftinguiih  them. 

f See  farther  of  the  acini  of  the  liver  for  example. 

§ Ruyfch  ad  Virarn  Clar.  H.  Boerlwave,  p.  S3- 


INTRODUCTION. 


13 


sisting  of  vessels  not  completely  surrounded  with  a membrane, 
and  resolvable  by  boiling  or  maceration.* 

Fo'lkules  are  little  bags  appended  to  the  extremity  of  the 
ducts,  into  which  the  secretion  is  made,  and  from  which  it  is 
evacuated  by  the  ducts.' 

Lacunas  are  little  sacs  opening  largely  into  the  passages,  (as 
in  the  urethra,)  and  into  which  generally  mucus  is  secreted  ; 
which,  lodging  there,  is  discharged  when  matter  moves  along 
the  passage. 

Finally,  we  have  to  recollect  that  every  part  of  the  body  se- 
cretes ; that  every  surface  is  a secreting  surface  ; that  even 
that  surface  which  is  produced  by  an  incision  no  sooner  ceases 
to  bleed  than  a secretion  begins.  And  that  an  ulcer  in  the  skin 
or  flesh  becomes  by  habit  similar  to  those  organs,  the  peculiar 
function  of  which  is  to  secrete  some  matter  useful  in  the  sys- 
tem. This  fact  corrects  the  notions  which  we  should  other- 
wise be  apt  to  receive  of  the  action  of  secretion  from  contem- 
plating the  more  complicated  glandular  organs. 

* “ Cryptarum  vafcula  poffum  docere,  fed  funt  tarn  fubtilia,  ut  reptatus  non 
pofiit  diftingui  ; tanturfi  circum  affufa  rubedo  per  repletionem  videtur.’’  Ruyfch 
ad  Her.  .Boerhaave,  p.  77, 


PART  THE  FIRST. 


OF  THE  ABDOMINAL  VISCERA . 


CHAP.  I. 


OF  THE  ABDOMEN  IN  GENERAL,  AND  OF  THE 
PERITONEUM. 

The  abdomen  is  that  division  of  the  body  which  is  betwixt 
the  thorax  and  pejvis.  It  is  bounded  above  by  the  arch  of  the 
diaphragm  ; behind,  by  the  spine  ; on  the  sides  and  fore  part, 
by  the  abdominal  muscles  ; and,  below,  the  abdominal  viscera 
are  supported  by  the  alae  ilii  and  the  pubes.  The  abdomen 
contains  the  viscera  more  or  less  immediately  connected  with 
digestion,  and  the  kidneys  which  secrete  the  urine. 

We  speak  of  the  cavity  of  the  abdomen:  but  it  is  an  inaccu- 
racy of  language  ; for  there  is  really  no  cavity : the  parietes 
of  the  abdomen,  viz.  the  abdominal  muscles  and  peritoneum, 
closely  embrace  the  contained  viscera.  To  understand  what 
is  meant  by  the  cavity  of  the  abdomen  ; to  understand  the 
connection  of  the  several  viscera,  and  the  manner  in  which 
they  lie  contiguous,  while  they  adhere  at  certain  points  only  ; 
we  must  previously  attend  to  the  peritoneum.  But,  in  the  first 
place,  let  us  notice  the  outward  divisions  of  the  belly. 

OF  THE  REGIONS  . OF  THE  BELLY. 

To  give  greater  accuracy  to  the  description  of  the  seat  of 
the  viscera,  or,  perhaps  rather,  more  strictly  to  connect  the 
knowledge  of  the  internal  parts  with  the  outward  marks  of  the 


16 


OF  THE  PERITONEUM. 


belly,  it  has  been  long  customary  to  mark  certain  arbitrary  di- 
visions on  its  surface,  which  are  called  regions. 

The  epigastric  region  is  the  upper  part  of  the  belly,  un- 
der the  point  of  the  sternum  and  in  the  angle  made  by  the  meet- 
ing of  the  cartilages  of  the  ribs  with  the  sternum.  Upon  the 
sides  under  the  cartilages  of  the  ribs  are  the  hypochondriac 
regions,  or  the  right  and  left  hypochondrium.  These  three 
regions  make  the  upper  division  of  the  abdomen,  in  which  are 
seated  the  stomach,  liver,  spleen,  pancreas,  duodenum,  and 
part  of  the  arch  of  the  colon.  The  space  surrounding  the  um- 
bilicus, betwixt  the  epigastrium  and  a line  drawn  from  the  crest 
of  one  os  ilii  to  the  other,  is  the  umbilical  region.  The 
hypogastric  region  is  of  course  the  lowest  part  of  the  belly, 
consisting  of  the  angle  betwixt  the  umbilical  region,  the  spines 
of  the  ossa  ilii  and  the  pubis.  The  two  lateral  spaces  betwixt 
the  false  ribs  and  the  spine  of  the  os  ilii  are  the  iliac  regions, 
or  the  loins. 


of  the  peritoneum. 

The  Peritoneum,  like  all  the  other  membranes  of  the  body, 
consists  of  an  expansion  of  dense  cellular  membrane  ; yet  it  is 
what  is  called  a proper  or  simple  membrane  ; being  a white 
firm  thin  contexture  of  cellular  substance,  in  which  no  fibre  or 
striated  appearance  is  to  be  observed.*  By  its  outer  surface  it 
adheres  to  the  adipose  membrane,  on  the  inside  of  the  abdo- 
minal muscles,  and  to  the  surface  of  the  several  viscera  ; its 
inner  surface  is  smooth,  and  forms  no  adhesion  while  the  parts 
are  sound  and  healthy  ; its  outer  surface  is  looser  in  its  texture, 
and  by  the  splitting  of  its  lamina  it  degenerates  into  the  com- 
mon cellular  membrane. 

The  cellular  membrane  on  the  outside  of  the  peritoneum  is 
in  some  places  short,  firm,  and  dense  ; as  on  the  liver,  the. 
spleen,  the  uterus,  and  the  intestines  : but  it  is  longer,  lax,  and 
fatty,  where  it  attaches  the  peritoneum  to  the  muscles  and  ten- 
dons of  the  abdomen. 

The  peritoneum  has  no  termination  ; or  it  is  a sac  ; yet  so 
curiously  is  it  involved  with  the  viscera,  that  though  we  say 
the  viscera  are  contained  in  the  abdomen,  yet,  accurately 
speaking,  they  are  without  the  peritoneum,  and  consequently 
lie  not  in  the  abdominal  cavity.f 

The  peritoneum  is  expanded  on  the  lower  surface  of  the 

* The  meaning  of  fome  anatomifls,  faying  that  the  peritoneum  is  a double 
membrane,  will  be  feen  below, 
f See  Plate  I.  and  the  explanation. 


OF  'fHE  PERITONEUI®. 


If 


diaphragm  ; and  at  some  of  the  interstices  or  perforations  of 
that  muscle  or  its  tendon  it  comes  in  contact  with  the  pleura, 
and  adheres  to  it  by  cellular  substance.  From  the  diaphragm 
the  peritoneum  is  reflected  off  to  the  liver,  forming  the  liga- 
ments of  thatviscus,  and,  expanded  over  its  surface,  it  forms 
its  outer  membrane.  From  the  diaphragm  it  is  also  sent  off 
upon  the  oesophagus  and  stomach,  and  prolonged  to  the  spleen 
on  the  left  side  (as  it  is  to  the  liver  on  the  right)  so  as  to  form 
the  ligaments  of  the  spleen. 

The  aorta,  the  great  vena  cava,  the  thoracic  duct,  and  the 
kidneys,  are  behind  the  peritoneum  ; that  membrane  being 
stretched  before  them.  But  the  intestines  are  also  in  the  same 
respect  behind  this  general.investing  membrane  : for  it  is  mere- 
ly reflected  from  the  spine  and  psoas  muscles,  and  from  the 
great  vessels  running  down  upon  the  spine,  so  as  to  involve 
the  intestines  and  form  their  outer  coat.  As  it  stretches  to- 
wards the  tract  of  the  intestinal  canal,  it  consequently  involves 
the  vessels  of  the  intestines  in  its  duplicature,  and  forms  the 
mesentery. 

The  peritoneum  also  lines  the  abdominal  muscles  : it  is  re- 
flected from  the  diaphragm  upon  the  surface  of  the  transversa- 
lis  and  rectus  abdominis  muscles.  Here  it  is  united  to  them 
by  a loose  adipose  membrane,  and  from  the  abdominal  mus- 
cles it  is  continued  upon  the  inside  of  the  pubes.  From  the 
pubes  it  ascends  upon  the  bladder  of  urine  ; descends  again  be- 
hind the  bladder  ; and  there,  making  another  reflection  to 
mount  over  the  rectum  and  form  the  meso-rectum,  it  leaves 
betwixt  the  rectum  and  bladder  a particular  sacculus. 

From  this  detailed  description  we  see  that  the  peritoneum 
has  no  termination  : that  it  is  continued  from  the  surface  of 
the  diaphragm  to  that  of  the  abdominal  muscles  ; from  that 
over  the  bladder  and  rectum  ; from  the  rectum  in  the  whole 
length  of  the  intestinal  canal  ; and  from  the  intestinal  canal  up 
upon  the  diaphragm.  We  see  then  what  is  meant  when  it  is 
said  that  it  is  a shut  sac  ; we  understand  by  the  cavity  of  the 
peritoneum  merely  the  inside  of  this  sac  ; and  that  when  dis- 
tended with  fluid,  that  fluid  is  contained  betwixt  the  peritone- 
um lining  the  abdominal  muscles  and  that  part  of  it  which  in- 
vests or  forms  the  outer  membrane  or  coat  of  the  intestines  — — 
This  fluid,  whether  collected  there  by  disease  or  thrown  in  by 
experiments,  has  no  natural  outlet,  nor  does  it  transude  in  the 
living  body.* 


* Soemmeiring,  Corp.  Hum.  Fab.  Contemp.  Peritonei,  § iii. 

We  not  unfrequentiy  find  an  accurate  general  defcription  in  authors,  but  fofne 
incorrectness  in  the  fubordinate  detail;  which  throws  back  the  ideas  of  the  reader 
into  confufion.  Such  is  the  enumeration  of  the  holes  or  perforations  of  the  p&rito- 

Vol.  IV.  C 


1$ 


OF  THE  PERITONEUM. 


BLOOD-VESSELS  OF  THE  PERITONEUM. 

As  the  peritoneum  is  a membrane  of  great  extent,  and  in- 
vesting a variety  of  parts,  its  vessels  come  from  many  sources. 
It  receives  arteries  and  veins  from  the  mammary  vessels  ; 
from  the  phrenic  and  epigastric  vessels  ; from  the  lumbar  arte- 
ries and  veins  ; and  from  the  ilio-lumbalis,  circumfiexa  ilii, 
renal,  and  spermatic  arteries.  It  receives  nerves  from  the  in- 
tercostal, lumbar,  and  diaphragmatic  nerves. 

It  would  appear  that  disease  has  given  rise  to  the  opinion 
that  the  peritoneum  has  in  it  many  little  glands.  This  is  con- 
troverted decisively  by  Morgagni.  • 

OF  THE  USE  OF  THE  PERITONEUM. 

The  peritoneum  serves  as  a dense  and  outer  coat  to  the  ab- 
dominal viscera  ; conveys  the  vessels  to  them,  as  in  the  exam- 
ple of  the  mesentery  ; and,  having  its  inner  surface  smooth  and 
lubricated  by  a watery  secretion,  it  allows  the  parts  to  lie  in 
contact  (they  being  strongly  compressed  by  the  surrounding 
abdominal  muscles  and  diaphragm,)  and  at  the  same  time  al- 
lows in  the  intestinal  canal  a capacity  of  motion  without  fric- 
tion. 

There  is  no  internal  surface  or  cavity,  as  it  is  called,  of  the 
living  body,  which  is  not  moistened  by  an  exudation  from  the 
vessels  of  the  surface.  Thus  it  i3  with  the  peritoneum.  An 
exhalation  from  the  extreme  arteries  bedews  its  surface,  and 
is  again  taken  up  by  absorbent  vessels  ; so  that  it  does  not  ac- 
cumulate in  health,  nay  even  fluids  poured  into  the  abdominal 
cavity  will  be  taken  up  by  the  absorbents.*  When  the  abdo- 
men is  opened  in  animals  alive,  or  recently  killed,  as  in  the 
shambles,  a vapour  is  seen  to  exhale  from  the  peritoneum 

neum,  “ pour  donner  paflage  a i’oefophage,  a la  veine-cave,”  &c.  See  Anatom, 
Chirurg.  par  M.  Palfm.  We  fee  that  there  are  no  fuch  perforations,  that  the  oefo- 
phagus  never  enters  into  the  cavity  of  the  peritoneum,  nor  does  the  reCtum  pafs 
out  from  its  cavity.  This  was  indeed  explained  by  Fernelius  in  oppofition  to  Ga- 
!en.  Pee  a defeription  of  the  inflections  of  the  peritoneum  by  Bartholin.— Speci- 
men Kifloris  Anatomies;  Analedt.  Ob.  I. 

* See  Nuck  Sialograph,  c.  ii.  p.  27. 

Qua  copia  in  ftatu  fecundum  naturam  fecernatur  didtu  difficile  eft  : ad  uncias 
certe  colletta  aquula  in  fani  hominis  abdomine  reperitur.  (Kaawn,  543.)  In 
homine,  cui  fponte  abdomen  fub  umbilico  ruptum  erat  ad  quinque  & fex  libras  de 
die  effluebat.  (Journ.  de  Med.  1 75 7 M.  Aug.  ut  denique  Boo  libr.  effluxerent.) 
This,  however,  proves  nothing  of  the  nature  or  quantity  of  the  fecretion  ; this  has 
probably  been  an  inflammation  and  abfeefs  of  the  peritoneum,  which,  we  have 
feen,  pours  out  fuch  a quantity  of  fluid,  thin  and  ferous,  as  quickly  to  drop  through 
the  bed-clothes  upon  the  floor. 


OF  THE  PERITONEUM. 


19 


having  a peculiar  animal  odour.  Yet  we  ought  not  to  say  that 
this  vapour  is  collected  in  the  dead  body  ; for  before  the  open- 
ing of  the  peritoneum,  or  the  death  of  the  animal,  it  is  not  in 
a state  of  vapour,  but  is  condensed  into  a watery  exudation.^ 

I have  seen,  in  the  high  state  of  inflammation  of  this  mem- 
brane, pus  formed  upon  the  surface  without  ulceration,  and 
therefore,  probably,  from  the  same  exhaling  or  secreting  sur- 
face ; and  coagulable  lymph  lying  in  flakes  upon  it.  The  in- 
crease of  the  serous  discharge  forms  the  common  ascites  ; but 
whenever  the  natural  secretion  or  exudation  from  the  peritone- 
um is  altered,  adhesions  are  apt  to  form. 

One  great  use  of  the  peritoneum  is  to  retain  the  viscera  in 
their  place,  says  Haller  ; for  when  it  is  wounded  they  escape, 
and  sometimes  with  a sudden  impetus,  which  makes  it  difficult 
to  reduce  or  retain  them.f  But  this  is  not  from  the  want  of  the 
embracing  of  the  peritoneum,  but  from  the  tendons  or  muscles 
which  support  the  peritoneum  being  cut  ; for  when  there  is  a 
deficiency  in  the  support  given  by  the  abdominal  muscles,  or 
their  expanded  tendons,  the  peritoneum  does  not  prevent  the 
viscera  from  being  protruded,  but  easily  yields  to  their  forci- 
ble protrusion,  and  forms  a sac  involving  this  hernia. 

Nor  do  the  processes  of  the  peritoneum,  which  have  re- 
ceived the  name  of  ligaments,  nor  the  mesentery,  nor  meso- 
colon, sufficiently  resist  the  prolapsus  of  the  viscera  when  they 
have  escaped  from  the  pressure  of  the  surrounding  muscles. 
Sufficient  example  of  this  we  have  in  hernia  of  the  intestines, 
in  which  the  mesentery  is  greatly  elongated,  or  in  the  displace- 
ment of  the  stomach,  or  in  the  prolapsus  and  procidentia  uteri. 

The  peritoneum  which  forms  the  sac  of  hernia  retains  little 
elasticity,  and  does  not  shrink  into  the  belly  when  freed  from 
the  outer  adhesions  ; but  the  general  peritoneum  will  allow 
great  distention,  as  in  ascites,  and  quickly  contract  to  its  for- 
mer dimensions  on  the  evacuation  of  the  fluid  ; and  so  that 
part  of  the  membrane  which  invests  the  stomach  and  intestines, 
the  bladder  of  urine  -and  gall  bladder,  has  considerable 
elasticity,  since  it  suffers  these  parts  to  be  distended  and  again 
returns  to  its  former  dimensions. 

The  consideration  of  the  insufficiency  of  the  peritoneum  to 
retain  the  viscera  leads  us  to  attend  to  a circumstance  of  the 
greatest  importance  connected  with  the  viscera  of  the  belly. 
The  abdomen  is  every  where  (except  towards  the  spine)  sur- 

* This  vapour  I have  feen  arifing  from  the  inteftines  of  the  human  body  during 
the  operation  for  hernia  ; and  alfo  when  the  omentum  and  inteftines  have  efcaped 
in  confequence  of  a wound  of  the  belly. 

\ Element.  Phyfiol.  tom.  ii.  p.  380. 


20 


or  THE  PERITONEUM. 


rounded  by  muscles.  Above  we  see  the  diaphragm  ; before, 
and  to  the  sides,  the  abdominal  muscles  ; and  even  below,  the 
parts  in  the  pelvis  are  surrounded  and  compressed  by  the  leva- 
tor ani,  in  such  a manner  that  the  whole  of  the  viscera  suffer  a 
continual  pressure.  This  pressure  upon  the  viscera  appears  to 
be  uniform  and  constant,  notwithstanding  the  alternate  action 
of  the  abdominal  muscles  and  diaphragm  as  muscles  of  respi- 
ration : but  it  must  be  occasionally  very  violent  during  exer- 
tions ; in  pulling,  for  example,  or  in  straining,  as  a sailor 
must  do  in  working  of  the  great  guns,  or  when  pulling  at  the 
oar,  or  when  balancing  himself  upon  his  belly  over  the  yard- 
arm. And  indeed  by  such  violent  and  general  compression  of 
the  viscera  of  the  belly,  ruptures  are  sometimes  produced,  of 
the  worst  kind,  and  followed  by  the  immediate  train  of  urgent 
symptoms. 

The  viscera  having  in  general  delicate  outer  coats,  and  no 
ligaments  capable  of  supporting  them,  and  being  very  vascu- 
lar, require  the  support  of  this  pressure  of  the  surrounding- 
muscles  ; and  the  great  venous  trunks  which  take  their  course 
through  the  abdomen  are  in  a particular  manner  indebted  to  the 
pressure  of  the  abdominal  parietes.  We  must  recollect  also 
the  bad  consequences  which  result  from  the  sudden  relaxation 
of  the  abdomen  ; as  in  women  after  deliver}7,  or  in  conse- 
quence of  withdrawing  the  waters  of  ascites  without  due 
compression  of  the  belly  ; languor,  faintness,  and  even  death, 
are  sometimes  produced,  apparently  by  the  balance  of  the 
vascular  system  being  destroyed. 

Some  good  authors  in  former  times  have  described  the 
peritoneum  as  a double  membrane.^  This  was  no  farther  a 
mistake  than  as  they  considered  the  cellular  membrane,  which 
lies  without  the  peritoneum,  as  a part  of  it.  It  is  necessary  to 
recollect  this  in  order  to  understand  the  meaning  of  their  call- 
ing the  sheath  of  the  cellular  membrane,  which  accompanies 
the  vessels  passing  out  from  the  abdomen,  productions  of  the 
peritoneum.  The  vaginal  productions  of  the  peritoneum  are 
the  shtaths  ol  the  common  cellular  substance  which  accompany 
the  aorta  and  oesophagus  into  the  posterior  mediastinum;  or 
which  give  a bed  to  the  spermatic  vessels,  or  passing  under 
PoupaiVs  ligament  accompany  the  vessels  of  the  thigh.  They 
are  improperly  termed  productions  of  the  peritoneum. 

The  proper  productions  or  prolongations  of  the  peritoneum 
are  of  a very  different  kind  ; thev  are  the  mesentery  and 
omenta  and  ligaments  : but,  as  I have  explained  in  general 
how  the  mesentery  and  ligaments  are  formed  by  the  peritone- 

8 See  .Ay.at.  Chirurg.  par  M.  Palfin,  tom.  II.  p.  35.  and  note  a. 


OF  THE  PERITONEUM. 


21 


tun,  and  as  they  must  come  presently  to  be  considered  more 
particularly,  we  treat  no  farther  of  them  here  A' 

OF  THE  OMENTA. 

The  Omenta  are  considered  as  secondary  processes  of  the 
peritoneum,  because  they  are  not  formed  by  the  peritoneum 
reflected  off  from  the  spine  upon  the  intestines,  as  the  mesen- 
tery is, — it  being  a primary  process  ; but  they  are  reflected 
from  the  surface  of  the  stomach  and  intestines.  Anatomists 
distinguish  the  omentum  majus^ — colico-gastricum  : the  omen- 
tum minus, — hepatico-gastricum  ; omentum  colicum  ; and 
lastly,  the  appendices  epiph  i :ae. 

The  omentum,  or  epiploon,  meaning  thereby  the  great 
omentum,  is  a floating  membrane  of  extreme  delicacy,  ex- 
panded over  the  surface  of  the  small  intestines,  and  attached 
to  the  great  arch  of  the  stomach  and  intestinum  colon. — 
Although  this  membrane  be  of  extreme  delicacy  and  transpa- 
rency in  the  young  subject,!  vet  it  is  much  loaded  with  fat, 
and  appears  transparent  in  the  interstices  only  ; and  in  advan- 
ced age  it  loses  much  of  its  delicacy,  and  acquires  a degree  of 
diseased  consolidation  or  firmness,  and  is  often  irregularly 
collected  into  masses,  or  adheres  preternaturally  to  some  of  the 
viscera. 

The  omentum  majus  hangs  suspended  from  the  cellular  con- 
nection betwixt  the  arch  of  the  stomach  and  the  great  trans- 
verse arch  of  the  colon  ; or  rather  it  forms  that  connection  be- 
twixt the  stomach  and  colon.  It  consists  of  two  membranes, 
or  is  as  a sac  collapsed  and  hanging  from  the  stomach  and 
colon,!  one  °f  the  sides  being  the  peritoneum  reflected  off 
from  the  oesophagus  and  along  all  the  great  arch  of  the  sto- 
mach, and  the  other  that  which  comes  from  the  arch  of  the 
colon.  And  further,  as  each  of  these  lamina  may  be  supposed 
to  consist  of  two  lamina  ; for  example,  where  the  omentum  is 
formed  by  the  meeting  of  the  peritoneum  from  the  lower  and 
upper  surfaces  of  the  stomach  ; these  two,  meeting,  form  the 
upper  lamina  : and  as,  where  the  lower  layer  of  the  omentum 
comes  off  from  the  colon,  it  is  alsoformed  by  the  peritoneum 

* See  farther  of  the  peritoneum  under  the  head  MefenterJ,  Mefocolon,  Dc- 
fcent  of  the  Tefticle,  &c. 

■f  Pr^terca  tenerrimas  effe  ut  nulla  membranarum  humanarum,  retina  oculi 
excepta,  tcquefit  tenera.  Haller,  vol.  vi  lib.  20.  § i.  par.  12. 

While  its  delicacy  is  remarkable  in  the  young  "fpliject,  the  retiform  veffels  (vid. 
Ruyfch.  Ther.  II.  V.  Spegil.  1.V1II.  &c.)  have  the  fat  accumulated  in 
their  tract  as  if  it  were  thrown  up  by  them  to  a fide  ; but  often  the  fat  increafing 
pbfeures  the  veffels. 

\ Marfupium  the  common  term.-— See  Window,  IV.  § 35 2. 


22 


OF  THE  PERITONEUM. 


reflected  in  the  same  manner  ; so  with  some  truth  the  omentum 
is  supposed  to  consist  of  four  lamina  of  membranes  of  extreme 
tenuity  ; but  these  four  layers  cannot  be  demonstrated.  The 
great  omentum  extends  from  the  bosom  of  the  spleen  trans- 
versely, until  it  terminates  on  the  right  side  of  the  arch  of  the 
colon,  where  the  omentum  colicum  begins. 

The  great  omentum  varies  considerably  in  extent.  In  a 
child  it  is  short ; in  the  adult  further  extended  over  the  visce- 
ra : sometimes  it  reaches  only  to  the  umbilicus  ; sometimes  it 
is  allowed  to  extend  its  margin  into  the  pelvis,  so  that  in  old 
people  it  is  very  apt  to  form  a part  of  the  contents  of  hernia  ; 
often  it  is  wasted  and  shrunk  ; sometimes  collected  into  masses 
leaving  the  surface  of  the  intestines. 

OF  THE  OMENTUM  MINUS  OR  HEPATICO  GASTRICUM. 

This  is  a membrane  of  the  nature  of  that  last  mentioned, 
but  in  general  less  loaded  with  fat.  It  is  extended  from  the 
liver  to  the  lesser  arch  of  the  stomach.  It  passes  off  from  the 
lower  surface  of  the  liver  at  the  transverse  fossa  ; from  the  fos- 
sa ductus  venosi ; invests  the  lobulus  spigellii ; involves  the 
branches  of  the  cseliac  artery  ; and  is  extended  to  the  lesser  cur- 
vature of  the  stomach  and  the  upper  part  of  the  duodenum.* 

OMENTUM  COLICUM. 

This  is  a continuation  of  the  great  omentum  upon  the  right 
side  of  the  great  arch  of  the  colon,  where  it  rises  from  the  ca- 
put coli  ; but  it  seldom  extends  its  origin  from  the  colon  the 
length  of  the  caput  coli.  It  can  be  inflated  like  the  great 
omentum. 

APPENDICES  EPlPLOICdE,  OR  OMENTULA  INTESTINI 
CRASSI. 

These  are  little  fatty  and  membranous  processes  which 
hang  pendulous  from  the  surface  of  the  colon  : they  are  of  the 
same  texture  and  use  with  the  greater  omentum  and  right  colic 
omentum. 

We  have  mentioned  that  the  omenta  are  double  reflections 
from  the  peritoneum,  and  consequently  they  may  be  inflated  so 
as  to  demonstrate  them  JO  be  perfect  sacs.  To  do  this  it  is  not 

* “ Macilentius  eft,  ct  vafa  liabet  minora.”  Winflow,  Haller.  Indeed  it  feems 
rather  to  anfwer  the  general  purpofe  of  a cellular  membrane  conveying  veffels, 
T&an  the  purpofes  of  the  omentum  rnaju*. 


OF  THE  PERITONEUM. 


required  to  puncture  any  part  of  them,  for  there  is  a natural 
opening  by  which  the  whole  may  be  inflated  in  a young  sub- 
ject, and  in  a healthy  state  of  the  viscera. 

This  natural  opening  into  the  purse  or  sac  of  the  omentum  is 
betwixt  the  membrane  involving  the  vessels  and  ducts  of  the 
liver,  and  the  peritoneum,  where  it  invests  the  vena  cava  be- 
twixt the  neck  of  the  gall  bladder  and  the  first  turn  of  the  duo- 
denum, or  where  the  lobulus  caudatus  hepatis  touches  the  du- 
odenum. By  introducing  a blow  pipe  into  this  natural  fissure 
the  foramen  of  Winslow,  the  omentum  minus  may  be  raised  : 
the  gastro  colic,  and  colic  omenta  may  be  inflated.  This  open- 
ing serves  as  a communication  betwixt  the  cavities  of  the 
omentum  and  the  general  peritoneal  cavity  ; but  I am  inclined 
to  think  it  is  very  frequently  destroyed  by  adhesion.* * * §  As  this 
opening  points  towards  the  right  side.  Dr.  Monro  thinks  it  a 
sufficient  reason  for  introducing  the  trochar  on  the  right  side  in 
the  operation  of  tapping  for  ascites,  (contrary  to  the  usual  cau- 
tion of  avoiding  the  liver,  which  is  so  often  diseased  in  this 
case,)  and  that  by  operating  on  the  left  side  he  thinks  the  water 
will  not  be  allowed  to  flow  from  the  sac  of  the  omentum. f It 
appears  to  me  that  it  will  flow  equally  well  from  whatever  point 
of  the  belly  the  water  is  drawn. 

There  is  a considerable  variety  in  the  form  of  the  omentum 
of  animals, j:  but  still  they  seem  to  shew  the  same  provision  of 
involving  the  intestines,  filling  up  the  inequalities  which  arise 
from  the  rounded  forms  of  the  viscera,  and  still  further  lubri- 
cating and  giving  mobility  to  the  intestines.^  The  surface  of 
the  omentum,  however,  seems  merely  to  furnish  a fluid  exu- 
dation like  the  general  surface  of  the  peritoneum  ; at  least  the 
idea  which  has  been  entertained  of  the  oil  or  fat  exuding  is 
quite  improbable.|| 

The  use  assigned  to  the  omentum  of  being  subservient  to 
the  function  of  the  liver  is  deservedly  neglected.^ 

* Winflow,  Duverney,  and  Haller. 

f Quer.  If  I fhould  fay  to  a patient,  by  punfluring  here  I am  in  danger  of 
thrufting  this  inftrument  into  your  liver  ; by  introducing  it  here  there  is  lefs  pofli- 
bility  of  any  fuch  accident,  though  I may  not  draw  off  all  the  water ; what  would 
be  her  anivver  f 

I Haller  Element.  Phyflol.  tom.  vi.  lib.  xx.  § 2 and  3.  • 

§ We  mull;  not  fuppofe  that  becaufe  a mad  man  ftabs  himfelf  in  the  belly,  and 
there  is  afterwards  found  coalition  of  the  inteftines  to  the  wounds,  the  omentum 
has  not  done  its  office,  (fee  Boerhaavii  Prelefliones,  vol.  i.  § 45.)  no  more  can  we 
give  credit  to  the  tale  told  by  Galen  (De  Ufu  Partium,  T.  iv.  c.  9.)  of  the  gladiator 
who  loft  part  of  the  omentum,  and  ever  after  had  a coldnefs  in  his  guts  ! at  leaft 
we  cut  out  a great  part  of  the  omentum  from  a man  without  any  fuch  fenfation  be- 
ing the  confequence  now-a-days. 

(I  “ Et  dum  halitu  pingui  & ipfa  oburgit  & peritoneum.”  Hale  loc.  cit.  Boer- 
haave,  &c. 

? Viz.  by  fupplylng  a grofs  oily  matter  to  the  vense  porta- ■ 


( 24  ) 


CHAP.  II. 

OF  THE  MEMBRANEOUS  VISCERA  OF  THE 
ABDOMEN.* 

Having  understood  the  nature  of  the  general  investing 
membrane  of  the  abdomen,  and  what  is  meant  by  its  cavity  and 
its  processes,  we  take  a general  survey  of  the  (Economy  of  the 
viscera,  before  entering  upon  the  minute  structure  of  the  parts 
individually. 

The  organs  destined  to  receive  the  food,  and  to  perform  the 
first  of  those  changes  upon  it  which  fit  it  (after  a due  succession 
of  actions)  for  becoming  a component  part  of  the  living  body, 
are  the  stomach  and  intestines  primarily  ; the  glandular  visce- 
ra, the  liver,  pancreas,  (and  in  all  likelihood  the  spleen,)  as 
subservient  or  secondary  organs.  I have  been  accustomed  in 
my  lectures  to  divide  these  parts  into  the  membranous  or  float- 
ing viscera,  (viz.  the  whole  track  of  the  intestinal  canal)  and 
the  glandular  viscera  ; or  perhaps,  what  is  still  better,  they 
ir»y  be  distinguished  into  those  parts  which  have  action  arid 
motion,  and  those  which  are  quiescent  or  possessed  of  no  pow- 
er of  contraction.  Thus  the  stomach,  intestines,  gall-bladder, 
and  bladder  of  urine  (though  this  belongs  to  the  pelvis)  have 
muscular  coats,  and  the  power  of  contracting  their  cavities  ; 
while  the  liver,  spleen,  pancreas,  and  kidneys,  have  no  mus- 
cularity but  in  their  vessels  and  excretory  ducts. 

This  division  of  the  viscera  may  lead  to  important  distinc- 
tions in  pathology.  During  inflammation,  it  is  observed,  that 
though  the  parts  possessing  a power  of  contraction  may  some- 
times lie  inactive  without  pain,  yet  in  those  parts  when  roused 
to  action  there  is  excruciating  pain.  On  the  other  hand,  it  often 
happens  that  the  glandular  and  solid  viscera  are  the  seat  of  long 
continued  disease,  which  is  attended  only  with  a dull  or  low 
degree  of  pain  ; while  the  anatomist  is  often  struck  upon  ex- 
amining the  body  after  death  with  the  wide  ravages  of  the 
disease. 

W e divide  the  intestinal  canal  into  three  parts  ; the  stomach, 
the  small  intestines,  the  great  intestines.  The  small  intestines 
are  subdivided  into  the  duodenum,  jejunum,  and  ileon.  The 

* Although  the  term  Vifcus  implies  more  particularly  the  flelhy  or  folid  con- 
tents, as  the  heart,  liver,  kidneys,  yet  we  life  it  in  general  for  all  the  parts 
contained  in  the  great  cavities. 


Of  THE  OESOPHAGUS.  &$ 

• 

great  intestines  are  subdivided  into  the  caecum,  colon,  and  rec- 
turn.  The  stomach  is  the  seat  of  the  digestive  process  : in  the 
duodenum  the  food  receives  the -addition  of  the  secretions  from, 
the  liver  and  pancreas,  and  is  still  further  adapted  to  animali- 
zation  ; in  the  long  tract  of  the  jejunum  and  ileon  the  nutri- 
tious part  is  absorbed  ; and  in  the  great  intestines  the  effete 
matters  are  carried  slowly  forward,  and  at  the  same  time  suf- 
fer a further  absorption  of  their  fluid  contents,  until  as  fasces 
they  lodge  in  the  rectum  or  last  division  of  the  canal. 

From  this  view  it  is  apparent  that  as  each  division  of  the  in- 
testinal canal  is  marked  by  some  peculiarity  in  its  use  or  func- 
tion, we  must  carefully  examine  their  minute  structure  as  in- 
dividual parts,  at  the  same  time  that  we  do  not  allow  our- 
selves to  forget  the  universal  connection,  the  integrity  of  the 
circle  of  actions,  and  the  (Economy  as  a whole.  With  this  in- 
tention, following  the  course  of  the  food,  and  with  a view  also 
to  connect  the  present  subject  with  the  last  part  of  vol.  iii.  we 
treat  first  of  the  oesophagus. 


SECTION  i. 


OF  THE  (ESOPHAGUS. 

The  (esophagus  or  gullet  is  a cylindrical  tube,  partly  mem- 
branous and  partly  fleshy  ; which  is  continued  from  the  pha- 
rynx down  behind  the  larynx  and  trachea  and  close  before  the 
spine.  Still  continuing  its  course  in  the  back  part  of  the  tho- 
rax, it  perforates  the  diaphragm,  and  expands  into  the  upper 
orifice  of  the  stomach  ; its  use  is  to  convey  the  food  by  deglu- 
tition into  the  stomach. 

Although'  with? many  authors  I call  it  a cylindrical  tube,  and 
it  may  take  this  form  when  dissected  from  the  body  and  inflat- 
ed, yet  during  life  it  lies  collapsed  with  its  inner  membrane  in 
dose  contact,  and  it  transmits  the  morsel  only  by  the  continued 
succession  of  the  contraction  of  its  fleshy  coat. 

The  upper  part  of  this  tube  is  called  the  pharynx.  It  may- 
be described  as  expanding  funnel-like,  and  is  attached  to  the 
occipital  bone,  pterygoid  processes  of  the  sphenoid  bone,  and 
jawbones;  and  further  down  it  is  kept  expanded  upon  the 
horns  or  processes  of  the  os  hyoides.  This  bag  is  very  fleshy, 
being  surrounded  with  muscular  fibres,  which  take  their  origin 
Voe.  IV.  D 


26 


OF  THE  (ESOPHAGUS. 

• 

from  the  neighbouring  points  of  bone  ; as  the  styloid  process* 
the  horns  of  the  os  hyoides,  the  thyroid  cartilage  by  which 
it  is  enabled  to  grasp  and  contract  upon  the  morsel  when  it  has 
been  thrust  by  the  tongue  behind  the  isthmus  faucium.  This 
strong  tissue  of  muscular  fibres  which  surrounds  the  pharynx, 
is  continued  down  upon  the  oesophagus  in  the  form  of  a sheath, 
which  has  been  called  vaginalis  tunica. 

STRUCTURE  OF  THE  (ESOPHAGUS. 

I believe  we  can  with  propriety  enumerate  no  more  than 
two  proper  coats  of  the  oesophagus  ; its  muscular  and  internal 
coat ; for  that  which  is  sometimes  considered  as  the  outer  coat, 
is  only  the  adventitious  cellular  membrane,  and  the  nervous 
coat  is  merely  cellular  tissue  connecting  the  muscular  and  inner 
coat. 

The  muscular  coat  of  the  oesophagus  greatly  surpasses  in 
strength  and  in  the  coarseness  of  its  fibres  any  part  of  the  whole 
tract  of  the  intestinal  canal.  There  may  be  very  distinctly  ob- 
served in  it  two  layers  of  fibres  ; an  external  one  consisting  of 
strong  longitudinal  fibres,  and  an  internal  one  of  circular  fibres. 
These  lamina  of  fibres  are  more  easily  separated  from  each 
other  than  those  in  any  other  part  of  the  body.f  But  an  idea 
is  entertained  that  the  one  set  of  fibres,  the  circular  and  inter- 
nal ones,  are  for  contracting  the  tube,  and  the  outer  ones  for 
elongating  and  relaxing  it.  I believe  on  the  other  hand  that 
thev  contract  together,  conducing  to  one  end,  deglutition.^; 

What  is  called  the  tunica  nerve  a is  the  cellular  connec- 
tion betwixt  the  muscular  and  inner  coat,  and  is  Very  lax,  inso- 
much that  the  muscular  coat  and  the  inner  coat  are  like  two 
distinct  tubes,  the  one  contained  within  the  other,  and  but 
slightly  attached.  This  appearance  is  presented  particularly 
when  the  oesophagus  is  cut  across. 

The  inner  coat  of  the  oesophagus  is  soft  ; glandular  villi 
are  described  as  being  distinguishable  on  its- -surface,  and  it  is 
invested  with  a very  delicate  cuticle  to  dull  the  ac&te  sensibili- 
ty, and  prevent  pain  in  swallowing.  It  in  every  respect  re- 

* See  vol.  i.  p.  141. 

f It  appears  that  the  oefophagus  can  be  ruptured  in  two  ways : acrofs,  by  the 
tearing  ol  the  longitudinal  fibres ; and  longitudinally,  by  the  reparation  of  the 
longitudinal  fibres.  This,  though  a rare  accident,  takes  place  in  violent  vomiting 
or  draining  to  vomit ; and,  in  the  firft  inftance,  the  tearing  acrofs  of  the  oefophagus 
feems  to  be  the  tffetfl:  of  the  action  of  the  diaphragm  on  the  oefophagus.  By  this 
accident  the  fluids  of  the  ftomach  are  poured  into  the  cavity  of  the  thorax. 

| See  farther  of  the  mufcular  coat  of  the  inteftines.  “ It  was  at  onetime  fup- 
poied  that  the  mufcular  fibres  of  the  cefophagus  had  a fpiral  direction.”  See  Ver- 
heyen,  and  Morgan.  Adverfar.  iii. 


OF  THE  OESOPHAGUS. 


27 


sembles  the  lining  membrane  of  the  mouth.  The  power, 
however,  which  the  oesophagus  seems  to  possess  of  resisting 
heat  depends  not  on  the  insensibility  bestowed  by  the  cuticle, 
but  is  owing  to  the  rapid  descent  of  the  hot  solids  or  liquids 
swallowed  ; for  when  they  happen  to  be  detained  in  the  gullet 
they  produce  a very  intolerable  pain.  This  inner  coat  has  an 
exhaling  surface,  like  the  rest  of  the  body,  with  particular 
glands  to  secrete  and  pour  out  that  mucus  which  lubricates  the 
passage  for  the  food. ^ The  inner  coat  is  capable  of  a great 
degree  of  distention,  but  it  is  not  very  elastic,  or  at  least  con- 
traction of  the  muscular  coat  throws  it  into  longitudinal  folds 
or  plicae.f 

In  the  neck,  the  oesophagus  lying  betwixt  the  cervical  verte- 
brae and  the  trachea,  is  at  the  same  time  in  a small  degree  to- 
wards the  left  side.  In  the  thorax  it  runs  down  betwixt  the 
pleura  of  either  side,  where  they  form  the  posterior  mediastin- 
um. Here,  even  when  it  descends  upon  the  dorsal  vertebrae, 
the  oesophagus  lies  rather  to  the  left  side  ; it  then  passes  under 
the  arch  of  the  aorta,  but  quickly  escapes  from  under  its  com- 
pression and  rises  on  the  right  side  of  the  aorta,  and  as  it 
passes  further  down  it  gets  more  and  more  before  the  aorta. 
This  is  sufficiently  apparent  when  we  attend  to  the  relation  of 
the  perforations  in  the  diaphragm  for  transmitting  the  aorta  and 
the  oesophagus. 

Behind  the  oesophagus,  in  the  thorax,  there  are  one  or  two 
lymphatic  glands, which  were  understood  by  Vesalius  to  belong 
to  the  oesophagus.  What  deceived  him  is  an  appearance  ge- 
nerally to  be  observed  in  these  glands.  The  lymphatics,  or 
the  small  branches  of  veins,  are  generally  filled  with  a black 
matter,  which,  extending  to  the  coats  of  the  oesophagus, 
resemble  very  much  the  ducts  of  the  glands  going  to  open  into 
the  oesophagus.:): 

The  inner  coat  of  the  oesophagus  shows  so  very  different  a 
texture  from  that  of  the  stomach,  and  this  difference  is  marked 
by  so  very  abrupt  a line,  as  sufficiently  to  indicate  that  the 

* Thefe  glands  fuffer  ulceration  and  fchirrous  hardening,  and  are  a terrible 
caufe  of  difficulty  of  fwallowing. 

t Some  part  of  the  food  lodging  in  the  natural  lacunae  of  the  cefophagus,  or 
fome  folid  body,  as  the  ftone  of  fruit  being  received  into  them,  has  been  the  caufe 
of  a fac  forming  in  the  pharynx  or  cefophagus.  And  it  has  happened  that  fuch  a 
fac,  gradually  and  for  years  enlarging,  has  formed  a bag,  into  which  nearly  the 
whole  food,  that  fhould  have  paflfed  into  the  ftomach,  was  received,  fo  as  to  opprefs 
the  cefophagus  and  occafion  a lingering  death.  An  example  of  this  is  to  be  feen  in 
my  mufeum. 

f Thefe  glands  in  the  pofterior  mediaftinum  are  fometimes  difeafed,  and  en- 
larged fo  as  to  comprefs  the  cefophagus  and  to  caufe  fo  permanent  an  obftrutftion  of 
deglutition  as  to  kill. 


28 


OF  THE  STOMACH. 


fluids  poured  out  from  the  oesophagus  are  very  distinct  from' 
those  ol  the  stomach,  and  have  no  power  of  digestion. 


SECTION  II. 


OF  THE  STOMACH. 

Seat,  Form,  Displacement  of  the  Stomach, 

The  stomach  lies  under  the  margin  of  the  ribs  of  the  left 
side,  and  chiefly  in  the  left  hypochondrium.  Its  greater  ex- 
tremity is  on  the  left  side,  in  contact  with  the  diaphragm  ; but 
towards  the  right,  the  shelving  edge  of  the  horizontal  lobe  of 
the  liver  is  betwixt  it  and  the  diaphragm.  On  the  lower  part  it 
is,  by  the  mesocolon  and  arch  of  the  colon,  divided  from  the 
small  intestines  ; and  to  the  greater  extremity  the  spleen  is  at- 
tache d by  vessels  and  by  the  loose  intertexture  of  the  omentum. 
The  stomach  may  be  said  to  be  a conical  sac  ; the  extremities 
of  which  being  made  to  approach  each  other,  gives  it  the 
curve  of  a hunter’s  horn,  and  gives  occasion  to  the  anatomist, 
in  strict  description,  to  remark  these  parts  ; the  superior  or 
cardiac  orifice  into  which  the  oesophagus  expands;  the 
tow  tit  or  pyloric  orifice,  which  leads  into  the  duodenum; 
the  i. ess  : r and  greater  curvatures  of  the  stomach. 

The  lesser  curvature  of  the  stomach  extends  from  betwixt 
the  two  orifices  ; includes  in  its  embrace  the  spine,  the  aorta, 
And  the  small  central  lobe  of  the  liver,  while  there  is  attached 
to  it  the  lesser  omentum.  The  greater  curvature  of  the  sto- 
mach is  the  outline  ol  its  distended  belly,  which  rises  above 
the  arch  of  the  colon,  and  is  marked  by  the  course  of  the 
gastro-epiploic  vessels. 

When  the  stomach  is  distended  the  lower  orifice  is  nearly  on 
a level  with  the  upper  one  ; but  when  the  stomach  is  allowed 
to  subside,  it  falls  considerably  lower  ; so  that  whilst  the  sto- 
mach is  lying  across  the  abdomen  it  is  also  tending  obliquely 
downwards.  The  ensiform  cartilage  will  be  found  to  present 
commonly  to  the  middle  of  the  stomach  ; and  the  lower  orifice, 
when  in  its  natural  situation,  is  opposite  to  the  fossa  umbili- 
calis  of  the  liver  : the  upper  orifice  is  kept  constantly  in  one 
place  from  the  stricter  connection  of  the  oesophagus  with  the 
diaphragm. 

Both  orifices  of  the  stomach  present  backward,  especially 


OF  THE  STOMACH. 


29 


the  upper  one,  while  the  lower  one  is  pointed  backward  and 
downward.  By  the  distention  of  the  stomach  the  great  arch 
is  extended,  the  orifices  are  directed  more  backward  and  to- 
Wards  each  other,  and  especially  the  greater  extremity  draws 
upon  the  oesophagus.  By  these  means  I conceive  that  there  is 
sometimes  produced  a difficulty  of  the  stomach  discharging  its 
contents  when  greatly  distended,  the  orifices  being  in  a great 
measure  turned  from  the  (Esophagus  and  duodenum. 

The  stomach  being  liable  to  frequent  varieties  in  its  degree 
of  distention,  the  natural  relation  of  parts  must  frequently  be 
altered.  It  ought  to  be  particularly  recollected,  that,  in  the 
living  body  the  stomach  is  supported  and  bound  up  by  the  in- 
testines ; so  that  the  great  curve  presents  : and  the  broad  ante- 
rior surface  which  the  stomach  presents  in  the  dead  body  is 
turned  directly  upward,  and  the  inferior  downward.*  By  the 
collapsing  of  the  stomach  and  the  consequent  falling  down  of 
the  liver  some  have  explained  the  sensation  of  hunger,  con- 
ceiving that  the  uneasy  sensation  proceeds  from  the  liver  being 
allowed  to  hang  upon  the  broad  ligament.f  From  the  great 
simplicity  of  mechanical  explanation,  physicians  have  eagerly 
indulged  in  them,  but  it  will  in  ^general  be  found  that  when 
thev  are  applied  to  the  explanation  of  the  phenomena  of  a liv- 
ing body  they  are  inadmissible. 

OF  THE  COATS  OF  THE  STOMACH. 

The  coats  or  membranes  forming  the  stomach  are,  the 
outer,  the  muscular,  the  nervous,  the  villous,  and  the  three 
cellular  coats.  For  these  subdivisions,  however,  I see  no  use, 
nor  are  they  authorised  by  the  natural  appearance  of  the  coats 
of  the  stomach.  When  there  is  a distinction  in  texture, 
structure,  or  function,  and  where  these  lamina  can  be  se- 
parated, we  should  consider  them  as  coats  ; but  a mere  inter- 
mediate tissue  of  vessels,  or  the  connecting  cellular  mem- 
brane, are  improperly  considered  as  distinct  tunics. 

First  coat. — From  what  has  been  already  said  of  the 
peritoneum,  it  will  readily  be  allowed  that  the  outer  coat  of  the 
stomach  is  formed  by  the  peritoneum  ; a coat  common  to  all 
the  intestines.  Were  this  not  sufficiently  evident  in  itself,  it 
might  be  ascertained  by  dissecting  the  peritoneum  from  the 
cardiac  orifice  of  the  stomach,  where  it  will  be  found  reflected 
from  the  diaphragm.  This  coat  is  firm,  simple  in  its  texture, 

• Thus  the  gaftro-epiploic  artery  prcfents  diredtly  forward.  It  has  been 
■wounded,  and  bled  both  into  the  ftomach  and  outwardly.  I fhould  conceive  it 
pofhble  in  fuch  a cafe  to  tie  the  artery. 

t Winflow. 


30 


OF  THE  STOMACH. 


having  no  apparent  fibrous  texture,  and  smooth  on  its  outer 
surface,  with  many  minute  vessels.  Under  the  peritoneal 
coat  is  the  first  cellular  coat,  being  in  fact  a short  cellular  tissue 
betwixt  the  peritoneal  coat  and  the  muscular  coat. 

Muscular  coat. — The  muscular  coat  ol  the  stomach 
consists  chiefly  of  two  lamina  of  fibres;  less  distinct  however 
than  those  of  the  (Esophagus,  or,  in  other  words,  more  closely 
and  irregularly  connected.  One  set  of  fibres  runs  longitudi- 
nally, that  is,  from  the  one  orifice  to  the  other  ; the  other  set 
runs  encircling  the  stomach  ; yet  there  are  such  irregularities 
that  it  is  difficult  in  every  place  to  recognize  the  two  great  and 
original  divisions  of  fibres  ; and  on  this  account  in  general 
three  strata  or  series  of  fibres  are  described.*  For  an  exam- 
ple of  this  apparent  irregularity,  there  comes  down  upon  the 
fiat  side  of  the  stomach  an  irregular  fasciculus  of  fibres,  appa- 
rently from  the  longitudinal  fibres  of  the  cardiac  orifice,  and 
continued  from  those  of  the  oesophagus,  which  yet  take  a 
course  fairly  encircling  the  stomach.  They  cannot  be  strictly 
said  tb  belong  to  either  the  circular  or  longitudinal  series,  and 
in  many  places  those  which  run  longitudinally  on  the  stomach 
seem  to  sink  and  lose  themselves  amongst  the  lower  fibres,  or 
are  reflected  into  transverse  fibres. 

Thtse  muscular  fibres  of  the  stomach  do  not  run  in  an  un- 
interrupted course,  but  split,  rejoin,  and  form  a kind  of  reti- 
form  texture  through  which  the  coats  beneath  are  at  intervals 
discernible.  This  structure  would  appear  to  bestow  a greater 
power  of  contraction  on  the  stomach.  The  strong  longitudinal 
fibres  which  are  seen  upon  the  oesophagus  form  the  outer  strat- 
um of  the  muscular  coat  of  the  stomach,  and  they  extend 
from  the  oesophagus  and  cardiac  orifice  in  a stellated  form 
along  the  upper  curvature,  and  downward  upon  the  great 
end  or  sacculus  ventrkuli.  Then  we  h ive  to  observe  a set  of 
circula  r fibres,  which  forming  rings  upon  the  great  end,  ex- 
tend tj.ver  all  the  stomach,  like  the  circular  fibres  of  the  arte- 
ries. These  fibres  do  not  each  encircle  the  stomach  entirely, 
but  while  their  general  direction  is  circular,  they  are  so  inter- 
woven that  no  one  fasciculus  can  be  followed  to  a great  extent. 
These  are  called  the  transverse  fibres  or  stratum  ; while 
the  deepest  stratum  consists  of  the  continued  circular  fibres  of 
the  oesophagus.  These  last  fibres  are  strong  upon  the  cardiac 
orifice,  and  may  be  presumed  to  form  a kind  of  sphincter  ; 
but  they  diminish  as  they  are  remote  from  the  superior  orifice. 

* The  moil  general  opinion  is,  that  there  are  three  layers  of  fibres  in  the  fto- 
mach.  Some  defcribd  an  external  longitudinal  feries  ; a middle  tranfverfe  ftrat- 
iim  ; and  again  the  internal  fibres  running  longitudinally.  See  Galeati  Acad,  dc 
Bologne. 


OF  THE  STOMACH. 


31 


The  lower  or  pyloric  orifice  of  the  stomach,  however,  is  more 
carefully  guarded  by  muscular  fibres  ; having  in  the  duplica- 
ture  of  the  inner  coats  a distinct  circular  ring  of  muscular 
fibres. 

The  cellular  tissue,  being  intermingled  with  the  muscular 
fibres,  connects  and  strengthens  them,  and  gives  the  appear- 
ance of  little  white  lines  interwoven  with  the  muscular  fibres, 
and  which  some  have  described  as  small  tendons.*  There  is 
also  to  be  observed  a broad  ligamentous  band  on  the  two  flat 
surfaces  of  the  stomach  towards  the  pylorus.  They  are  like 
the  bands  of  the  colon,  but  not  nearly  so  strong  or  evident. — - 
They  are  formed  by  the  denser  nature  of  the  cellular  tissue, 
and  more  intimate  union  betwixt  the  first  and  second  coats. 

OF  THE  ACTION  OF  THE  MUSCULAR  COAT. 

Upon  considering  the  weakness  of  the  muscular  fibres  of  the 
stomach,  and  the  membranous  nature  of  the  whole  coats,  it 
appears  that  the  general  action  of  the  stomach  is  slow,  regular, 
and  by  no  means  a forcible  contraction  ; not  an  apparatus  for 
triturating  the  food,  but  merely  giving  motion  to  its  contents. 
But  regarding  the  extreme  sensibility  of  the  stomach,  and  the 
gradual  and  regular  succession  of  action,  much  will  be  found 
that  is  worthy  of  attention.  It  should  seem  that  the  morsel  is 
sent  down  into  the  oesophagus  by  a succession  of  actions,  pre- 
ceded by  a perfect  relaxation  ; and  that  when  the  food  arrives 
at  the  superior  orifice  of  the  stomach,  by  the  same  relaxation 
preceding  the  contraction,  the  muscular  fibres  of  the  upper  part 
of  the  stomach  yield  and  receive  the  food  compressed  by  the 
oesophagus.  Attending  to  the  form  of  the  stomach,  we  see  a 
provision  for  the  reception  of  the  food  into  the  great  sacculated 
fundus  on  the  left  extremity.  And  here  we  shall  find  that  there 
is  a greater  profusion  of  vessels  for  the  secretion  of  the  juices 
of  the  stomach,  and  a set  of  muscular  fibres,  probably  relaxing 
and  yielding  to  receive  the  food,  and  excited  to  action  only 
when  the  process  of  digestion  has  been  in  part  or  entirely  ac- 
complished. We  have  proof  that  when  the  food  has  remained 
the  usual  time  in  the  stomach,  and  comes  in  succession  to  be 
presented  at  the  lower  orifice,  if  the  stomach  is  healthy  and  the 
change  upon  the  food  perfect,  the  lower  orifice  is  relaxed,  and 
yields  to  the  contraction  of  the  muscular  fibres  of  the  stomach, 
and  the  contents  of  the  stomach  are  passed  into  the  duodenum  : 
but  if  the  food  has  been  of  an  indigestible  nature,  it  is  rejected. 
The  pyloric  fibres  refuse  the  necessary  relaxation,  and  by  the 


See  Winilow,  fed:,  viii.  p.  57. 


32 


QF  THE  STOMACH. 


unnatural  excitement  an  antiperistahic  motion  is  produced, 
and  the  matter  is  again  thrown  into  the  great  end  of  the  sto- 
mach, or  rejected  by  vomiting.  There  is  in  the  natural  action 
of  the  stomach  a stimulus,  followed  by  a regular  succession  of 
motion  in  its  fibres,  conveying  the  contents  from  the  upper  to 
the  lower  orifice  of  the  stomach.  Of  this  excitement  and  ac- 
tion we  are  not  conscious  ; but  when  the  action  is  disordered 
by  an  unusual  excitement,  the  lower  orifice  is  not  unlocked, 
the  action  becomes  violent  (the  reverse  of  what  naturally  takes 
place,)  and  pain  or  uneasy  feelings  are  produced.  Upon  this 
principle  may  be  explained  the  nausea  and  vomiting  which 
take  place  at  certain  times  after  eating,  when  balls  or  concre- 
tions are  lodged  in  the  stomach.  While  the  food  lies  in  the 
greater  extremity,  or  in  the  body  of  the  stomach,  and  the  ball 
or  concretion  with  it,  there  is  no  great  excitement ; but  when 
it  has  suffered  the  necessary  change,  and  is  approaching  to  ehe 
pyloric  orifice,  this  part,  being  as  it  were  a guard  upon  the  in- 
testines, is  suddenly  excited,  vomiting  is  produced,  and  the 
ball  is  thrown  into  its  old  place  in  the  sacculus  or  great  end. 

This  great  sensibility,  producing  effects  almost  like  intelli- 
gence, is  apparent  in  the  more  common  disorders  of  the  sto- 
mach. We  shall  find  the  meteorismus  ventriculi  (the  great 
distention  of  the  stomach  by  flatus)  existing  for  weeks,  and 
yet  the  food  passing  in  regular  course  through  its  orifices. — 
We  shall  find  very  frequently  food  of  difficult  digestion  laying 
in  the  stomach  and  oppressing  its  functions  for  days,  while  food 
more  recently  received  may  have  undergone  the  actual  chan- 
ges, and  have  passed  through  the  pylorus  into  the  duodenum. 

Owing  to  the  same  slow  and  successive  action  of  the  sto- 
mach, it  often  happens  that  ulceration  and  schirrus  pylorus,  or 
other  obstruction  of  the  lower  orifice  of  the  stomach,  is  attend- 
ed with  pain,  nausea,  and  vomiting,  only  at  stated  intervals 
after  taking  food  ; z.  e.  at  the  time  in  which  the  food  should  be 
sent  into  the  intestines  in  the  natural  course  of  action. 

The  muscular  fibres  of  the  stomach  are  excited  by  stimuli, 
applied,  not  to  their  substance,  but  to  the  contiguous  coats  ; 
and  betwixt  the  delicate  surface  of  the  inner  coat  and  the  mus- 
cular fibres  there  is  the  strictest  sympathy  and  connection.— 
The  same  connection  holds  in  a less  intimate  degree  betwixt 
the  outer  coat  and  the  muscular  fibres  ; for  when  a part  on  the 
surface  of  the  stomach  of  a living  animal  is  touched  with  acid 
or  stimulating  fluids,  the  part  contracts.*  The  stomach  is  con- 

•“  In  ea  fcde  qua  tangitur,  contrahitur,  fulcufque  profundus  nafcitur,  et  ruga: ; 
cibufque  aliquando  propellitur  ut  a fede  contradla  fugiat.  Minus  tamen  quam  in- 
teflina  ventriculus  irritabilis  eft  ; hinc  emetica  fortiora  needle  eft  purgantibus,” — - 
Haller. 


0F  THE  STOMACH; 


33 


sidered  as  less  irritable  than  the  intestines,  because  it  is  alleged 
that  a stronger  dose  of  a medicine  is  required  to  prove  emetic 
than  to  act  as  a purgative  : but  we  ought  to  consider  that  the 
action  thus  excited  in  the  intestines  is  merely  an  acceleration 
of  their  secretions  ; but  vomiting  is  the  interruption  of  the  usu- 
al action,  requiring  such  a violent  excitement  as  to  invert  the 
natural  action. 

But  there  is  something  more  than  this  ; as  the  function  of 
the  stomach  differs  from  that  of  the  intestines,  so  may  the 
quickness  of  their  action.  Thus  in  the  stomach  a gradual 
change  is  to  be  produced  upon  the  food,  requiring  time  and  a 
slow  degree  of  motion  ; but  in  the  intestines  there  is  a greater 
agitation  of  their  contents,  and  a quicker  action  of  their  coats, 
to  bring  the  fluids  into  more  general  contact  with  the  absorbing 
surface,  and  to  give  greater  activity  probably  to  the  absorption 
by  the  lacteals.  I am  inclined  to  think  that  the  stomach  is  the- 
most  irritable  part  of  the  body,  and  susceptible  of  the  most 
minute  distinctions  in  the  nature  of  the  stimuli  applied  to  it. — 
The  phenomena  of  the  living  animal,  and  experiments  in  those 
recently  killed,  sufficiently  prove  the  contractile  powers  of  the 
two  orifices.  Experiments  have  been  made  which  shew  the 
powers  both  of  the  cardiac  and  of  the  pyloric  orifices  in  retain- 
ing the  contents  of  the  stomach  after  the  oesophagus  and  duo- 
denum have  been  cut  across.  The  stomach  of  a rabbit  has 
been  squeezed  in  the  hand  after  cutting  the  duodenum,  with- 
out any  of  its  contents  having  escaped  and  in  similar  expe- 
riments, the  finger  being  introduced  into  the  lower  orifice  of  the 
stomach  of  an  animal  yet  warm,  the  fibres  of  the  pylorus  were 
found  to  contract  strongly  upon  it.  Upon  forcibly  compres- 
sing the  stomach,  the  food  will  be  made  to  pass  into  the  oeso- 
phagus much  more  readily  than  into  the  duodenum  ; which  is 
another  proof  how  necessary  the  natural  series  of  actions  is  to 
the  relaxation  of  the  pylorus. 

Of  vomiting — When  there  is  an  unusual  or  unnatural  irri- 
tation on  the  stomach,  or  when  it  is  violently  stimulated  or  op- 
posed in  its  natural  course  of  action,  the  motion  becomes  inver- 
ted ; and  drawing  by  sympathy  other  muscles  to  its  aid,  the 
contents  of  the  stomach  are  evacuated  by  vomiting.  Thus 
where  the  food  takes  changes  inconsistent  with  healthv  diges- 
tion ; or  when  solid  matters  lodge  in  the  stomach  ; or  when 
secretions  of  the  duodenum  pass  into  the  stomach,  or  unusual 
actions  are  propagated  backwards  upon  the  stomach  from  the 
upper  portion  of  the  canal ; or  when  emetics  are  taken,  which 
are  unusual  stimuli  ; or  when  there  is  inflammation  in  the  sto- 


* See  a paper  in  the  3d  vol.of  Sandifort,  Thef. 

Vol.  IV.  E 


34 


OF  THE  STOMACH. 


mach,  which,  from  giving  greater  sensibility,  produces  th,e 
same  effect  with  more  violent  stimuli  ; or  when  the  coats  are 
corroded  or  ulcerated  ; — vomiting  is  produced.  That  vomit- 
ing may  be  produced  by  the  inverted  motion  of  the  stomach 
and  (Esophagus  alone,  is  apparent  from  experiments  upon  liv- 
ing animals,  where  the  abdominal  muscles  are  laid  open,  and 
from  cases  in  which  the  stomach  has  lain  in  the  thorax,  and  yet 
been  excited  to  active  vomiting.**  Again,  it  is  equally  evident 
that,  when  the  stomach  is  excited  to  vomiting,  there  is  consent 
of  the  abdominal  muscles,  by  which  they  are  brought  into  vio- 
lent and  spasmodic  action  ; not  alternating  in  their  action,  as 
in  the  motion  of  respiration,  but  acting  synchronously,  so  as 
greatly  to  assist  in  compressing  the  stomach  : but  at  the  same 
time,  the  action  of  these  muscles,  however  forcible  their  con- 
traction, cannot  alone  cause  vomiting  ; nor  has  this  action  any 
tendency  to  produce  such  an  effect  on  other  occasions  in  which 
the  utmost  contraction  of  the  diaphragm  and  abdominal  mus- 
cles is  required  to  the  compression  of  the  viscera.  Many  have 
conceived  that  vomiting  is  entirely  the  effect  of  the  action  of 
the  abdominal  muscles  and  diaphragm.  Such,  for  example, 
has  been  the  opinion  not  only  of  J.  Hunter,  but  of  Duverney, 
and  of  M»  Chirac  in  Hist,  de  l’Acad.  des  Sciences,  1700.  M. 
Littre  opposed  this  notion,  and  contended  before  the  Acade- 
my, that  the  contraction  of  the  diaphragm  was  the  principal 
cause  of  vomiting.  M.  Lieutaud  in  1 752  supported  the  idea 
that  vomiting  is  the  effect  of  the  action  of  the  stomach.  He 
found,  upon  dissection,  in  a patient  whose  stomach  had  resist- 
ed every  kind  of  emetic,  that  it  was  greatly  distended  and  be- 
come insensible  ; and  concluded  that  the  want  of  action  in  the 
stomach,  and  consequent  loss  of  the  power  of  vomiting,  was  a 
strong  proof  of  the  action  being  the  effect  of  the  contraction  of 
the  stomach  only.  There  are  other  more  curious  instances  of 
disease  of  the  stomach  preventing  the  muscular  contraction  in 
any  violent  degree,  and  consequently  the  absence  of  the  usual 
symptom  of  vomiting : — an  instance  of  this  kind  will  be  seen 
in  Dr.  Stark’s  work.  In  my  Museum,  Surgeons’  Square, 
there  is  a preparation  of  a stomach,  in  which  the  walls  had  be- 
come so  thick  that  they  could  no  longer  suffer  contraction  by 
the  muscular  fibres ; the  consequence  of  which  was  that, 
although  the  inner  coat  of  the  stomach  was  in  a raw  and  ulce- 
rated state,  there  was  no  active  vomiting. 

The  singultus  seems  the  partial  exertion  of  the  sympathy 
betwixt  the  upper  orifice  ol  the  stomach  and  the  diaphragm,  by 
which  a kind  of  weak  spasmodic  action  is  excited  in  it,  but 


See  Wepfer  de  Cicuta  Aquatica.  p.  68. — Sauvage’s  Vomitus, 


OF  THE  STOMACH. 


35 

without  a concomitant  inverted  action  in  the  stomach  and  oeso- 
phagus. It  is  a convulsive  and  sonorous  inspiration,  owing  to 
an  irritation  of  the  upper  orifice  of  the  stomach  and  oesophagus, 
but  not  exactly  of  that  kind  which  causes  inversion  of  the  na- 
tural actions  of  the  stomach.  Thus  we  have  the  hoquet  des 
gloutons,  the  singultus,  from  some  medicines  and  poisons, 
from  some  crude  aliment,  or  even  from  some  foreign  body 
sticking  low  in  the  oesophagus,  or  from  inflammation.  The 
borborygmi  and  rumination  seem  to  be  gentler  inverted  actions 
of  the  upper  orifice  of  the  stomach  and  oesophagus,  unassisted 
by  any  great  degree  of  compression  of  the  stomach  by  the  ab- 
dominal muscles  and  diaphragm. 

The  full  action  of  vomiting  is  preceded  by  inspiration,  which 
seems  a provision  against  the  violent  excitement  of  the  glottis, 
and  the  danger  of  suffocation  from  the  acrid  matter  of  the  sto- 
mach entering  the  wind-pipe  ; for  by  this  means  the  expiration 
and  convulsive  cough  accompanying  or  immediately  following 
the  action  of  vomiting,  frees  the  larynx  from  the  ejected  mat- 
ter of  the  stomach.  But  the  action  of  the  diaphragm  is  farther 
useful  by  acting  upon  the  mediastinum,  which  embraces  the 
oesophagus,  and  no  doubt  supports  it  in  this  violent  action. 

NERVOUS  OR  VASCULAR  COAT  OF  THE  STOMACH. 

What  Haller  calls  the  nervous  coat,  is  the  cellular  structure 
in  which  the  vessels  and  nerves  of  the  stomach  ramify  and  di- 
vide into  that  degree  of  minuteness  which  prepares  them  for 
passing  into  the  innermost  or  villous  coat.  It  may  with  equal 
propriety  be  called  the  nervous,  the  vascular,  or  the  great  cellu- 
lar coat.'*'  Taking  it  as  the  third  distinct  coat  of  the  stomach, 
it  is  connected  with  the  muscular  coat  by  the  second  cellu- 
lar coat,  and  with  the  villous  coat  by  the  third  cellular 
coat.  Strictly,  however,  it  is  the  same  cellular  membrane, 
taking  here  a looser  texture  to  allow  of  the  free  interchange 
and  ramification  of  vessels.  When  macerated,  it  swells  and 
becomes  like  fine  cotton,  but  has  firmer  and  aponeurotic-like 
filaments  intersecting  it,  and  it  can  be  blown  up  so  as  to  demon- 
strate its  cellular  structure.!  It  is  in  this  coat  that  anatomists 
have  found  small  glandular  bodies  lodged,  especially  towards 
the  extremities  or  orifices  of  the  stomach. 

Villous  coat. — This  is  the  inner  coat,  in  which  the  ves- 
sels are  finally  distributed  and  organized  to  their  particular 


* To  call  it  cellular  coat,  however,  would  be  to  confound  it  with  the  three  ceU 
iular  coats  generally  enumerated  by  authors, 
f Win  flow.  fedt.  viii.  p.  64. 


36 


OF  THE  ST0MA6H. 


end.  It  is  of  greater  extent  than  the  outer  coats  of  the  ste? 
mach  ; which  necessarily  throws  it  into  folds  or  plicse.  These 
folds  take,  in  different  animals,  a variety  of  forms  : but  they 
are  simple  in  man  ; from  the  (Esophagus  they  are  continued  in 
a stellated  form  upon  the  orifice,  but  form  no  valve  here.  In 
the  body  of  the  stomach  they  are  more  irregular,  sometimes 
retiform,  and  sometimes  they  form  circles  or  squares,  but  they 
have  generally  a tendency  to  the  longitudinal  direction.  In 
the  pyloric  orifice  the  villous  coat  forms  a ring,  called  the  valve 
of  the  pylorus,  which,  however,  has  no  resemblance  to  a valve 
in  its  iorm  or  action.  This  ring  is  not  formed  by  the  inner 
coat  of  the  stomach  alone,  but  by  the  inner  stratum  of  fibres  of 
the  muscular  coat,  the  vascular  and  cellular  coats,  and  the  in- 
ner or  villous  coat.  The  effect  of  all  these  coats,  reflected  in- 
ward at  the  lower  orifice,  is  to  form  a tumid  and  pretty  thick 
„ring,  which  appears  like  a perforated  circular  membrane  when 
the  stomach  has  been  inflated  and  dried ; but  in  neither  state 
is  its  direction  oblique  so  as  to  act  as  a valve.  It  seems  capa- 
ble of  resisting  the  egress  of  the  food  from  the  stomach,  or  the 
return  of  the  matter  from  the  duodenum,  merely  by  the  action 
of  the  circular  fibres  which  are  included  in  it. 

On  the  surface  of  the  inner  coat  of  the  stomach,  small  reti- 
form rugae  and  a pile  of  innumerable  villi  are  observed.  But 
this  structure  of  the  stomach  has  not  been  so  fully  examined, 
and  is  not  so  perfectly  understood  as  the  analogous  appearance 
in  the  intestines.  Glands  are  also  described  as  opening  upon 
the  inner  surface  of  the  stomach : and  those  who  have  not  been 
able  to  see  these  glands,  which  are  seated  in  the  third  cellular 
coat,  yet  believe  in  their  existence  from  analogy  ; while  others 
observe  foramina  toward  the  upper  and  lower  orifice  of  the 
stomach,  which  they  suppose  to  be  the  opening  or  ducts  of 
glands.  These,  however,  which  I believe  to  be  merely  cryp- 
tse  or  follicles,  are  themselves  the  secreting  surface,  and  not 
the  ducts  of  the  proper  round  glandular  bodies  ; at  the  same 
time  it  must  be  admitted  that  disease,  as  if  magnifying  and  giv- 
ing size  to  the  structure  of  the  stomach,  shews  a glandular  and 
tuberculated  structure. 

Gastric  fluid.  There  is  secreted  into  the  stomach  a 
fluid,  which  is  the  chief  agent  in  digestion.  The  most  common 
opin  ion  is  that  it  flows  from  the  extreme  arteries  of  the  villous 
coat  in  general,  partly  from  the  mucous  cryptas  and  ducts.* — 
When  pure,  it  is  a pellucid,  mucilaginous  liquor,  a little  salt 

* But  I fhould  confider  thefe  glands  rather  as  analogous  to  the  mucous  follicles 
»f  the  oefophagus  and  lower  portion  of  the  inteftine,  and  merely  as  lubricating  and 
defending  the  paffages. 


OF  THE  STOMACH. 


o/ 

and  brackish  to  the  taste  like  most  other  secretions,  and  having 
the  power  of  retarding  putrefaction  and  dissolving  the  food. — 
It  acts  on  those  substances  which  are  nutritious  to  the  animal, 
and  which  are  peculiarly  adapted  to  its  habits.  It  has,  con- 
sequently, some  variety  of  properties  in  different  animals 

The  secreting  powers  of  the  stomach  seem  so  far  to  accommo- 
date themselves  to  the  food  received  into  it,  that  the  property 
of  the  gastric  fluid  is  altered  according  to  the  nature  of  the 
food.  This  affords  another  argument  in  favour  of  a simple 
diet ; since  in  a variety  of  condiments  received  promiscuously 
into  the  stomach,  the  chance  is  the  greater  of  some  ingredient 
becoming  an  offensive  load. 

It  seems  to  be  a peculiarity  in  the  human  stomach,  that  it 
has  a greater  capacity  for  digesting  a variety  of  animal  and  ve- 
getable bodies.  But  I should  at  the  same  time  conceive  that 
the  natural  power  of  digesting  the  simple  and  appropriate  food 
is  diminished  as  the  stomach  gains  the  power  of  dissolving  a 
variety  of  substances.  In  other  creatures,  a sudden  change  of 
food  is  rejected,  and  the  powers  of  the  stomach  are  found  in- 
capable of  acting  duly  on  the  aliment,  though  time  so  far  ac- 
commodates the  gastric  fluid  to  the  ingesta  that  the  animali- 
zation  becomes  perfect.  Mr.  Hunter  speaks  of  the  power  of 
cattle  eating  and  digesting  their  secundines.*  I have  known 
a cow  die  from  this  ; the  membranes  being  found  coiled  up 
within  the  bowels.  But  the  fact  is  sufficiently  ascertained,  that 
the  nature  of  the  digestive  process  may  be  sogfmr  altered  that 
graminivorous  animals  may  be  made  to  eat  flesl|>  and  carni- 
vorous animals  brought  to  live  upon  vegetables.  This  fact 
throws  us  back  from  the  simple  idea  which  we  should  be  apt 
to  entertain  of  the  nature  of  the  change  produced  by  digestion, 
viz.  that  it  is  simply  chemical.  For  we  see  that  the  nature  of 
the  solvent  thrown  out  from  the  stomach,  and  its  chemical  pro- 
perties, may  be  changed  by  an  alteration  in  the  action  of  the 
coats  of  the  stomach.  Thtis  we  are  baffled  in  our  inquiries, 
and  brought  back  to  the  consideration  of  this  living  propertv, 
which  can  so  accommodate  itself  to  the  nature  of  the  ali- 
ment. 

The  gastric  fluid  has  been  collected  from  the  stomachs  of 
animals  after  death,  by  sponges  which  the  animal  has  been 
made  to  swallow,  or  which  have  been  thrust  down  into  its  sto- 
mach, incased  in  perforated  tubes.  And,  lastly,  it  has  been 
obtained  by  exciting  the  animal  to  vomiting,  when  the  stomach 
was  empty  ; for  the  secretions  of  the  stomach  are  then  poured 


See  OMervations  on  Digeftion. 


38 


OF  THE  STOMACH. 


out  unmixed  with  food.*  Although  by  these  means  a fluid 
may  be  obtained  which  may  properly  be  called  the  succus  gas- 
tricus, yet  it  must  contain  a mixture  of  the  saliva,  and  secre- 
tions from  the  glands  of  the  (esophagus  and  pharynx,  with  the 
glandular  secretions  of  the  stomach,  and  the  general  vascular 
secretion  from  the  surface  of  the  stomach.  It  is  a fluid,  then, 
upon  which  the  chemist  can  operate  with  no  hope  of  a suc- 
cessful or  uniform  result.  And  indeed  chemistry  seems  no 
farther  to  assist  us  in  forming  an  accurate  conception  of  the 
changes  induced  upon  the  fluids  in  the  alimentary  canal,  than 
that  the  more  perfect,  but  still  very  deficient,  experience  of 
the  modern  chemist  successfully  combats  the  speculations  of 
the  chemists  of  former  ages.  For  example;  it  was  formerly 
supposed  that  digestion  was  a fermentation,  and  that  this  fer- 
mentation was  communicated  and  propagated  by  the  gastric 
juice.  It  is  now  found  that  the  gastric  juice  has  properties  the 
reverse  of  this  ; that  it  prevents  the  food  from  taking  an  acid 
or  putrefactive  fermentation  ; that  it  acts  by  corroding  and  dis- 
solving the  bodies  received  into  the  stomach  ; and  that  it  is  it- 
self at  the  same  time  converted  into  a new  fluid,  distinct  in  its 
properties.!  It  is  almost  superfluous  to  observe,  that  the  gas- 
tric juice  has  no  power  of  acting  upon  the  coats  of  the  stomach 
during  life  ; whether  this  be  owing  to  the  property,  in  the  living 
fibres,  of  resistance  to  the  action  of  the  fluid,  or  that  there  is  a 
secretion  bedewing  the  surface,  which  prevents  the  action,  it  is 
not  easy  to  say,^>ut  more  probably  it  is  owing  to  the  resistance 
to  its  actiort  inherent  in  a living  part. 

Of  digestion.  By  trituration  and  mastication,  and  the 
union  of  the  saliva  with  food  in  the  mouth,  it  is  merely  pre- 
pared for  the  more  ready  action  of  the  stomach  upon  it.  No 
farther  change  is  induced  upon  it  than  the  division  of  its  parts 
and  the  forming  of  a soft  pulp.  But  in  the  stomach,  the  first 
of  those  changes  (probably  the  material  one)  is  performed, 
which  by  a succession  ol  actions  fits  the  nutritious  matter  for 
being  received  into  the  circulation  of  the  fluids  of  the  living 
body,  and  for  becoming  a component  part  of  the  animal.  For 
now  the  gastric  juice  acting  on  this  fluid  mass  quickly  dissolves 

* By  Spallanzani. 

f Tlie  moft  curious  fad  is  that  property  of  the  coats  of  the  ftomach,  or  of  the 
fluids  lodging  in  the  coats  of  the  ftomach,  by  which  milk  and  the  ferum  of  the 
blood  are  coagulated.  It  has  been  found  that  a piece  of  the  ftomach  will  coagulate 
fix  or  feven  thoufand  times  its  own  weight  of  milk  This  adtion  feems  a necefia- 
ry  preparation  for  digeftion,  which  fhews  us  that  the  moft  perfect  and  finiply  nutri- 
tious fluid  is  yet  improper,  without  undergoing  a change,  to  he  received  into  the 
fyftem  of  veffels.  For  example  ; milk  and  the  white  of  eggs  are  firft  coagulated, 
and  then  pafs  through  the  procefs  of  digeftion.  See  J.  Hunter,  Animal  CEconomy, 
Obfervations  on  Digeftion. 


OF  THE  STOMACH. 


39 


the  digestible  part,  and  entering  into  union  with  it  produces  a 
new  fluid,  which  has  been  called  chyme.  The  mass  has 
changed  its  sensible  and  chemical  properties;  it  has  suffered 
the  full  action  of  the  stomach,  and  by  the  gradual  and  succes- 
sive muscular  action  of  the  stomach  it  is  sent  into  the  duode- 
num. The  contents  of  the  stomach  consist  of  air  (partly 
swallowed,  partly  extricated  by  chemical  change,  but  still  more 
in  all  probability  by  the  heat ;)  of  chyme ; and  of  a grosser 
part  incapable  of  becoming  nutritious,  and  the  separation  of 
which  from  the  chyme  is  accomplished  by  the  action  ol  the 
canal.  Now  the  stomach  being  stimulated  by  fulness,  by  fla- 
tus, and  more  still  by  the  peculiar  irritation  of  the  food  to 
which  it  is  natural  to  suppose  its  sensibility  is  adapted,  the 
muscular  coat  is  brought  into  action,  and  the  contents  of  the 
stomach  delivered  into  the  duodenum.  Here  having  additional 
ingredients,  it  is  farther  changed  in  its  nature,  and  approxi- 
mates more  to  that  of  the  fluids  circulating  in  the  vessels.  It 
is  called  chyle  ; it  has  become  a white  milky  fluid,  which  by 
the  property  of  the  living  surface  of  the  villous  coat  is  separated 
from  the  mass,  and  absorbed  by  the  lacteal  vessels  of  the  in- 
testines.* 

Hunger  and  thirst.  We  are  solicited  to  take  food  by 
the  uneasy  sensation  of  hunger,  and  by  the  anticipation  of  the 
voluptuous  sating  of  the  appetite,  and  by  the  pleasures  of  the 
palate.  Hunger  is  considered  as  the  effect  of  the  attrition  of 
the  sensible  coats  of  the  stomach  upon  each  other  bv  the 
peristaltic  motion  of  the  stomach  and  compression  of  the 
viscera.  This  appears  to  be  too  mechanical  an  explanation. 
If  the  sensation  proceeded  merely  from  such  attrition  of  the 
coats  of  the  stomach,  food  received  into  the  stomach  would  be 
more  likely  to  aggravate  than  to  assuage  the  gnawing  of  hun- 
ger ; tp  excite  the  action  of  the  stomach  would  be  to  excite  the 
appetite,  and  an  irritable  stomach  would  be  attended  with  a 
voracious  desire  of  food.  Something  more  than  mere  empti- 
ness is  required  to  produce  hunger.  There  appears  to  be  a 
deficiency  of  the  due  stimulus  to  the  stomach,  and  a conse- 
quent uneasy  sensation  which  is  allayed  by  fulness.  Hunger 
does  not  appear  to  be  occasioned  by  stimulus,  but  by  a want  of 
due  excitement,  by  which  the  irritability  of  the  coats  and 
action  of  the  vessels  are  as  it  were  suffered  to  accumulate  ; 
and  this  tension,  and  irritation,  and  fulness  of  vessels,  is  re- 
lieved by  the  food,  which  excites  the  action,  draws  out  the 
fluids,  and  gives  activity  to  the  system  of  vessels. 

Thirst  is  seated  in  the  tongue,  fauces,  oesophagus,  and 


* See  farther  of  the  lafteal  and  abforbent  fyftem. 


40 


OF  THE  SMALL  INTESTINES. 


stomach.  It  depends  on  the  state  of  the  secretions  which 
bedew  these  parts,  and  arises  either  from  a deficiency  of 
secretion  or  from  an  unusually  acrid  state  of  it.  It  would  ap- 
pear to  be  placed  as  a monitor  calling  for  the  dilution  of  the 
fluids  by  drink,  when  they  have  been  exhausted  by  the  fatigue 
of  the  body  and  by  perspiration,  or  when  the  contents  of  the 
stomach  require  a more  fluid  state, — the  more  easily  to  suffer 
the  necessary  changes  of  digestion. 

The  cardiac  orifice  is  the  chief  seat  of  all  sensations  of  the 
stomach  both  natural  and  unusual,  as  it  is  the  most  sensible 
part  of  the  stomach.  Indeed  we  might  presume  this  much  by 
turning  to  the  description  and  plates  of  the  nerves  ; for  we 
shall  find  that  this  upper  part  of  the  stomach  is  provided  in  a 
peculiar  manner  with  nerves,  the  branches  of  the  par  vagum. 

The  sympathy  of  the  stomach  with  the  rest  of  the  intestinal 
canal,  the  connection  of  the  head  and  stomach  in  their  affec- 
tions, the  effect  of.  the  disorder  of  the  stomach  on  the  action 
of  the  vascular  system  and  of  the  skin,  and  the  strict  consent 
and  dependence  betwixt  the  stomach  and  diaphragm  and  lungs, 
and  in  a particular  manner  with  the  womb,  testicle,  &c. — and 
again,  the  connection  of  the  stomach  with  the  animal  (Econo- 
my, as  a whole, — must  not  escape  the  attention  of  the  student 
of  medicine. 


SECTION  III. 

OF  THE  SMALL  INTESTINES. 

The  small  intestines  are  described  as  that  part  of  the  intes- 
tinal canal  which  is  betwixt  the  pyloric  orifice  of  the  stomach 
and  the  valve  of  the  colon.  They  are  reckoned  in  length  at 
four  or  five  times  the  height  of  the  body  : they  form  that  part 
of  the  canal  in  which  the  digestion  is  completed,  and  the  nu- 
tritious fluids  absorbed  from  the  waste  of  the  ingesta.  They 
are  commonly  subdivided  into  the  duodenum,  jejunum,  and 
ileon  ; or  more  simply  into  the  duodenum  and  intestinum 
tenue.* 

OF  THE  DUODENUM. 

The  duodenum  stands  distinguished  from  the  general  tract 
of  the  small  intestines  by  its  shape,  connections,  and  situation. 


* Haller. 


OF  THE  SMALL  INTESTINES.. 


41 


It  is  greatly  larger  than  any  other  part  of  the  small  intestines  ; 
irregularly  circular  ; more  fleshy  ; and,  although  it  has  fewer 
plicfe,  it  is  more  glandular  and  more  vascular  : hut  its  greatest 
peculiarity,  and  that  which  must  convince  us  of  its  importance 
in  the  animal  (economy,  and  of  the  necessity  of  attending  to  it 
in  disease,  is  this,  that  it  is  the  part  which  receives  the  biliary 
and  pancreatic  ducts,  and  in  which  a kind  of  second  stage  o£ 
digestion  takes  place  ; and  that  by  the  disorder  of  these 
secretions  it  must  be  primarily  affected.  The  duodenum  takes 
a course  across  the  spine  from  the  orifice  of  the  stomach  un.il 
it  touches  the  gad- bladder.  First  it  goes  in  a direction  down- 
ward ; then  it  passes  upward  till  it  touches  the  gall-bladder  ; 
then  making  a sudden  turn  it  descends  directly  near  to  the 
right  kidney,  and  is  then  involved  in  the  lamina  of  the  mesoco- 
lon ; it  then  takes  a sweep  towards  the  right  side,  obliquely 
across  the  spine,  and  a little  downward  ; it  afterwards  runs 
behind  the  head  of  the  pancreas  and  the  great  vessels  passing  to 
the  small  intestines  betwixt  the  vena  cava  and  the  vena  portse  ; 
and  then  again  toward  the  left  of  the  aorta,  but  still  hound 
down  by  the  root  of  the  mesocolon.^  This  portion  of  the  in- 
testine receives  its  name  from  being  usually  measured  off 
twelve  fingers  breadth,  or  from  five  to  six  inches,  from  the  ori- 
fice of  the  stomach.  I have  always  preferred,  however,  a 
natural  and  not  an  arbitrary  division,  and  have  considered  that 

fiortion  of  the  intestines  as  duodenum,  which  is  above  the 
ower  lamina  of  the  mesocolon,  or  the  point  at  which  it 
emerges  from  the  stricture  of  the  mesocolon.  As  in  this  ex- 
tent, besides  being  tied  down  to  the  spine  by  the  mesocolon,  it 
has  the  peritoneum  reflected  off  from  it  at  other  points,  we 
have  to  remark  the  ligamentum  duodeni  renale,  ligamentum 
duodeni  hepaticum. 

Although  we  shall  presently  treat  of  the  coats  of  the  small 
intestines  in  general,  yet  it  may  not  be  improper  here  to  ob- 
serve what  are  announced  as  peculiarities  in  the  coats  of  this 
first  division.  The  first  or  peritoneal  coat  is  imperfect,  as 
must  already  be  understood  : for  it  does  not  invest  the  whole 
circumference  of  the  gut  ; it  ties  it  down  more  closely,  or  it 
merely  contains  it  in  its  duplicature,  while  a greater  profusion 
of  cellular  membrane  accompanies  this  than  the  other  divisions 
of  the  intestines.  The  muscular  coat  is  stronger  than  that  ot 
the  jejunum  and  ileon  ; the  plies  formed  by  the  inner  coats, 

* How  comes  it  then,  feeing  the  acute  turns  of  this  inteftine,  that  Ruyfch 
calls  it  “ Inteftinum  digitate,  vel  inteftinum  rectum  brcviffimum  ?’’  Adverfar. 
Anat.  Decad.  II. 

See  a good  defcription  of  the  duodenum  by  M.  Laurent  Bonazzoli,  in  fhc 
Tranfadtions  of  the  Academy  of  Bologna. 

Vol.  IV.  F 


42 


OF  THE  SMALL  INTESTINES- 


smaller  than  those  of  the  other  part  of  the  small  intestine,  ancl: 
having  more  of  a glandular  structure.  At  the  lower  part  of 
the  first  incurvation  of  the  duodenum,  the  inner  coat  forms  a 
particular  process  like  to  those  which  are  called  valvulse  con- 
niventes  ; and  in  this  will  be  discovered  the  opening  of  the 
biliary  duct,  within  which  also  the  ductus  pancreaticus  gene- 
rally opens. 

It  is  not  without  some  reason  that  anatomists  have  consider- 
ed the  duodenum  as  a second  stomach,  calling  it  ventriculus 
secundus,  and  succenturiatus  ; for  there  is  here  performed  a 
change  upon  the  food,  converting  the  chyme,  (as  they  have 
chosen  to  call  it,)  which  is  formed  in  the  stomach,  into  perfect 
chyle.  But  to  suppose  that  the  chyme  is  perfected  in  the 
duodenum,  is  to  suppose  the  biliary  and  pancreatic  secretions 
necessary  to  the  formation  of  chyle  ; a point  which  is  not 
allowed  : for  many  suppose  that  the  bile  is  merely  a stimulus 
to  the  intestines,  holding  a controul  over  their  motions  ; others, 
that  it  is  useful  only  in  separating  the  chyle  from  the  excre- 
ment ; or  again,  that  the  bile  is  decomposed,  part  entering  into 
the  composition  of  the  chyle,  while  the  other  goes  into  that  of 
the  faeces  : it  seems  to  bestow  upon  them  a power  of  stimulat- 
ing the  intestinal  canal  in  a greater  degree  ; and  as  the  chyle  is 
formed  occasionally  without  the  presence  of  bile,  we  may  be 
induced  the  more  readily  to  allow  that  the  bile  does  not  in  the 
natural  actions  and  relations  of  the  systems  enter  into  the  com- 
position of  the  chyle.  At  all  events,  we  see  that  it  is  the  bile 
which  is  the  peculiar  stimulus  of  the  intestinal  canal,  and  that 
when  interrupted  in  its  discharge  from  the  ducts,  the  motions 
of  the  belly  are  slow,  and  costiveness  is  the  consequence. 

We  see,  then,  that  at  all  events  there  are  poured  into  the 
duodenum  from  the  liver  and  pancreas,  secretions  which  have 
an  extensive  effect  on  the  system  of  the  viscera ; and  we  must ' 
acknowledge  that  the  derangement  of  these  secretions  must 
operate  as  a very  frequent  and  powerful  cause  of  uneasiness, 
and  that  the  duodenum  must  often  be  the  seat  of  disease  and 
distressing  symptoms.  We  may  observe  that,  from  the  course 
of  the  duodenum,  pain  in  it  should  be  felt  under  the  seventh 
or  eighth  rib,  passing  deep,  seeming  to  be  in  the  seat  of  the 
gall-bladder,  and  stretching  towards  the  right  hypochondrium, 
and  to  the  kidney,  and  again  appearing  as  if  on  the  loins. 
We  may  observe  farther,  that  from  the  connections  of  this 
portion  of  the  intestine,  and  from  the  manner  in  which  it  is 
braced  down  by  the  mesocolon,  spasm,  when  flatus  is  con- 
tained in  it,  will  sometimes  produce  racking  pains.  Nay  far- 
ther, when  the  irregularities  of  digestion  affect  the  duodenum, 
and  spasm  and  distention  follow  ; the  distention  causes  it  to 


OF  THE  SMALL  INTESTINES. 


43 


press  upon  the  gall-bladder,  and  the  pressure  and  the  excite- 
ment together  cause  an  irregular  and  often  an  immoderate  flow 
of  bile,  which  with  the  acrid  state  of  the  food,  produces  anxie- 
ties and  increased  pain,  inverted  motion,  vomiting,  and  even 
cholera.* 

W e must  not  forget,  that  the  inverted  action  of  the  stomach 
draws  quickly  after  it  the  inverted  motion  of  the  duodenum. 
It  may  be  of  consequence  to  attend  to  this  in  the  operation  of 
an  emetic,  for  the  stomach  will  sometimes  appear  to  be  dis- 
charging foul  and  bilious  matter  which  we  naturally  may  sup- 
pose to  have  been  lodged  in  it,  but  which  has  actually  flowed 
from  the  duodenum,  or  has  even  come  recently  from  the  ducts 
in  consequence  of  the  operation  of  the  vomit,  f 

From  a defect  in  the  natural  degree  of  the  stimulating  pow- 
er of  the  bile,  it  will  accumulate  in  the  duodenum,  occasioning 
anxiety  and  loss  of  appetite,  and  even  congestion  of  blood  and 
a jaundiced  skin  ; we  may  certainly  affirm  that  these  at  least 
are  often  connected.  Such  accumulation  in  the  duodenum 
must  be  attended  with  a languid  action  of  the  whole  canal,  and 
inactivity  of  the  abdominal  viscera,  because  the  peristaltic  mo- 
tion is  begun  here  in  the  natural  action  of  the  intestines and  if 
its  peculiar  stimulus  be  deficient,  so  must  that  of  the  whole  sys- 
tem of  the  viscera.  Hence  the  necessity  of  rousing  and  evacu- 
ating the  whole  canal. 

I may  farther  observe,  that  it  has  been  the  opinion  of  the 
most  respectable  old  physicians,  those  vvhose  knowledge  of  dis- 
eases has  been  drawn  from  an  acquaintance  with  anatomy, 
from  the  frequent  inspection  of  dead  bodies,  and  the  observa- 
tion of  the  symptoms  during  life,  that  the  study  of  the  diseases 
connected  with  the  duodenum  is  the  most  important  which  can 
occupy  the  attention  of  the  medical  enquirer. 

OF  THE  SMALL  INTESTINES  IN  GENERAL. 

The  small  intestines,  under  the  name  of  jejunum  and  ileon, 
occupy  the  space  in  the  middle  and  lower  part  of  the  abdomen, 
the  great  mass  forming  convolutions  in  the  umbilical  region. 
The  cylindrical  canal  of  the  small  intestines  is  gradually  and 
Imperceptibly  diminished  in  diameter  as  it  is  removed  from  ;he 
lower  orifice  of  the  stomach;  so  that  the  terminal  on  of  the 
ileon  in  the  caput  coli  is  considerably  smaller  than  the  duode- 
num. This  tract  of  the  small  intestines  performs  the  most  im- 

* Indeed  vomiting  in  confequence  of  concuffion  and  compreflion  upon  the  whole 
■.outents  of  the  abdomen,  and  in  a particular  manner  on  the  liver,  affords  moft 
powerful  means  of  operating  upon  the  infardfion  and  remora  of  the  blood  in  the 
hepatic  fyflem. 

t bee  Samlifort,  vol.  iii.  p,  288.  See  Hoffman. 


44 


OF  THE  SMALL  INTESTINES. 


portant  function  of  the  chylipoetic  viscera  (if  any  can  be  said 
to  be  peculiarly  important  where  the  whole  is  so  strictly  con- 
nected ;)  for  here  the  food  is  moved  slowly  onward  through  a 
length  of  intestine  more  than  four  times  the  length  of  the  bo~ 
dv,* * * §.and  exposed  to  a surface  amazingly  extended  by  the  pen- 
dulous and  loose  duplicatures  of  the  inner  coat.  Here  the 
fteces  are  gradually  separated  from  the  chyle,  and  the  chvle 
adhering  to  the  villi  is  absorbed  and  carried  into  the  system  of 
Vessels. 

The  jejunum|  is  the  upper  portion  of  the  small  intestine. 
Its  extent  is  two- fifths  of  the  whole.  Its  convolutions  are 
formed  in  the  umbilical  region. 

The  i L eon  lies  in  the  epigastric  and  ileac  regions,  surrounds 
the  jejunum  on  the  sides  and  lower  part,  and  forms  three-fifths 
of  the  whole  extent  of  the  intestine  from  the  mesocolon  to  the 
valve  of  the  colon.  The  coats  of  the  ileon  are  generally  de- 
scribed as  thinner  and  paler  ; the  valvular  projections  of  the 
inner  coat  less  conspicuous:  and  the  mucous  glands  are  appa- 
rent in  the  lower  portion.  The  several  parts  however  of  this, 
which  we  may  call  the  long  intestine, J do  not  preserve  a very 
exact  relation  in  regard  to  their  place  in  the  belly,  but  in  their 
motions  they  may  be  drawn  to  the  right  or  left,  upward  or 
downward.  Tiiis  however  I am  convinced  takes  place  in  a 
much  less  degree  than  is  generally  believed. 

There  is  sometimes  found  a lusus  in  the  lower  part  of  the 
ileon  before  it  passes  into  the  colon  ; a blind  pouch  or  caecum 
is,  as  it  were,  attached  to  the  ileon  resembling  the  caput  coli.  I 
have  found  this  in  one  instance  only.  Sometimes  there  is  more 
than  one  in  the  course  of  the  ileon.§ 

MINUTE  STRUCTURE  OF  THE  SMALL  INTESTINES. 

We  have  in  some  measure  anticipated  the  general  enumera- 
tion and  character  of  the  coats  of  the  intestines,  by  what  has 

* The  whole  length  of  the  inteftinal  canal  is  generally  eftimated  at  from  fix  to 
feven  times  the  length  of  the  whole  body. 

1-  So  named  Iron’  its  being  more  generally  empty.  Indeed  the  higher  parts  of 
the  canal  can  never  he  diftended,  becaufe  the  contents  pafs  flowly  and  gradually 
and  with  little  interruption  through  them  ; but  they  are  in  a manner  accumulated 
below. 

f We  m’ay  then  fpealc  of  the  firall  inteftines  in  general,  meaning  the  whole 
tradl  from  the  ftomach  to  the  great  inteftine  ; the  duodenum  being  the  fpace  be- 
twixt the  ftomach  and  the  lower  lamina  of  the  mefocolon,  the  long  inteftine  being 
the  trail  extending  from  the  duodenum  to  the  colon. 

§ The  appendices  citcalesof  the  ileon  have  given  birth  to  a curious  queftion  in 
the  pathology  of  hernia.  See  “ Hernia  ab  ilii  diverticulo.”  Morgagni,  Adv. 
Anat  III.  “ Hernie  formee  par  1’appendice  dc  l’ileon.”  Littre,  Mem.  de 
l’Acad.  Royaie  de.  Sciences,  an  1700;  Ruyi'ch,  Pulfin,  &c.  See  cafes  of  anus  at 
the  groin  in  the  Mufcum,  Surgeons’  Square. 


OF  THE  SMALL  INTESTINES. 


45 


been  said  upon  the  coats  of  the  stomach  ; for  we  have  here  to 
distinguish  the  four  great  coats,  the  peritoneal,  the  muscular, 
the  vascular,  and  villous  coats. 

THE  PERITONEAL  COAT  AND  MESENTERY. 

The  peritoneal  coat  of  the  small  intestines  is  of  the  same 
nature  with  that  of  the  stomach,  liver,  spleen,  &c.  It  is  a thin, 
smooth,  pellucid  membrane.  On  the  surface  it  has  a moisture 
exuding  from  its  pores  ; and  it  firmly  adheres  to  the  muscular 
fibres  beneath.  Its  transparency  makes  the  muscular  fibres, 
blood-vessels,  and  lymphatics  easily  distinguishable  ; and  when 
it  is  dissected  or  torn  up,  the  longitudinal  muscular  fibres  will 
be  found  in  general  attached  to  it.  Its  use  is  to  give  a smooth 
surface  and  strengthen  the  intestine,  and  in  a great  measure  to 
limit  the  degree  of  this  distention. 

The  peritoneal  coat  of  the  intestine  is  continued  and  reflect- 
ed off  upon  the  vessels  and  nerves  which  take  their  course  to  the 
intestine  : or,  what  is  the  same  thing,  and  indeed  is  the  more 
common  description,  the  two  laminae  of  the  peritoneum  which 
form  the  mesentery,  after  proceeding  from  the  spine  and  in- 
cluding the  vessels,  nerves,  and  glands  belonging  to  the  tract 
of  the  intestine,  invest  the  cylinder  of  the  intestine  under  the 
name  of  peritoneal  coat.*  The  mesentery  is  composed  of 
membranes,  glands,  fat,  and  the  several  systems  of  vessels,  ar- 
teries, veins,  lacteals,  and  nerves.  As  in  reality  it  is  a pro- 
duction of  the  peritoneum,  it  may  be  said  to  arise  from  the  me- 
socolon, or  the  mesocolon  from  the  mesentery,  reciprocally. 
But  at  present  we  may  trace  the  mesentery  from  the  root  of  the 
mesocolon  ; for  the  jejunum,  emerging  from  under  the  em- 
brace of  the  mesocolon,  carries  forward  the  peritoneum  with 
it ; and  the  laminae  of  the  peritoneum,  meeting  behind  the  gut, 
include  the  vessels  which  pass  to  it  and  form  the  mesentery. 
This  connection  of  the  small  intestines  by  means  of  the  pro- 
longation ol  the  peritoneum,  while  it  allows  a considerable  la- 
titude of  motion,  preserves  the  convolution  in  their  relations, 
and  prevents  them  from  being  twisted  or  involved.  But  it  is 
by  the  walls  of  the  abdomen  that  the  intestines  as  well  as  the 
more  solid  viscera  are  supported  ; for  when  the  bowels  escape 
by  a wound,  a portion  ot  an  intestine  will  hang  down  upon  the 
thigh,  unrestrained  by  the  connection  with  the  mesentery. 

1 he  mesentery  begins  at  the  last  turn  of  the  duodenum,  or 
beginning  of  the  jejunum.  Its  root  runs  obliquely  from  left 
to  right  across  the  spine.  Here  it  has  no  great  extent ; but  as 

•See  Plate  I.  5.6.  7.8. 


48 


OF  THE  SMALL  INTESTINES. 

Vf 

readily  yield  to  the  relaxation  that  follows,  as  in  the  natural 
contraction,)  or  when  there  is  a mechanical  and  obstinate  in- 
terruption to  the  contents  of  the  bowels  ; then  i?  the  natural 
action  reversed.  This  antiperistaltic  motion  must  arise  thus  ; 
a portion  of  the  intestine  being  constricted,  and  not  yielding  to 
the  contraction  which  in  the  natural  action  of  the  gut  should 
follow  in  order,  the  motion  of  the  gut  must  be  stationary  tor  a 
time,  until  the  part  above  is  again  relaxed  ; when,  the  con- 
tents of  the  intestine  finding  a free  passage  upwards,  and  that 
portion  contracting  and  propelling  the  matter  still  upwards  and 
retrograde,  (since  it  is  opposed  by  the  contraction  below,)  a 
series  of  retrograde  or  antiperistaltic  motions  are  produced. 
The  course  of  the  action  is  changed  ; the  contraction  of  the 
gut  is  not  followed  by  the  dilatation  of  the  part  below,  but  by 
that  of  the  part  above.  By  this  means  the  matter  of  the  lower 
portion  of  the  intestinal  canal  is  carried  into  the  upper  part, 
and  there  acting  as  an  unusual  stimulus  it  aggravates  and  per- 
petuates the  unnatural  action.  Nav,  from  experiments  it  ap- 
pears that  a permanent  irritation  will  cause  an  accelerated  mo- 
tion in  both  directions,  that  from  the  point  stimulated  there 
will  proceed  downward  the  regular  series  of  contractions  and 
dilatations,  while  the  motion  is  sent  upwards  and  retrograde 
from  the  same  point  of  the  intestine  toward  the  stomach.* 
And  this  observation,  the  exhibition  of  medicine  and  the  dis- 
eases of  the  intestines  confirm.  But  farther  we  may  observe, 
that  the  food  is  not  uniformly  moved  downward  ; it  is  shifted 
and  agitated  by  an  occasional  retrograde  motion  thus  : 


• Haller,  loc.  cit.  Exper.  424. 


OF  THE  SMALL  INTESTINES* 


49 


The  portion  of  the  intestine  included  under  A contracts  and 
sends  its  contents  into  B.  B contracting  sends  its  fluid  con- 
tents in  part  backward  into  A,  but  in  a greater  portion  into  C. 
While  the  contents  of  the  middle  portion  are  sent  into  the 
lower  part  in  a greater  proportion  than  into  the  higher  division, 
the  tendency  of  the  food  will  be  in  its  natural  course,  down- 
ward ; whilst  at  the  same  time  it  suffers  an  alternate  motion 
backward  and  forward  ; so  that  it  is  more  extensively  applied 
to  the  absorbing  surface  of  the  intestines. 

The  stimulus  to  the  intestines  is  matter  applied  to  their  inner 
coat  ; and  although  there  is  much  sympathy  in  the  whole 
canal,  yet  unless  there  be  matter  within  a portion  of  the  canal, 
that  particular  part  has  little  action.  Accordingly,  when  there 
is  obstruction  to  the  course  of  the  aliment,  by  whatever  cause 
it  may  be  produced,  the  portion  below  becomes  shrunk  and 
pale,  and  free  from  the  effects  of  inflammation  ; while  that 
stimulated  by  the  food,  being  in  a high  state  of  excitement, 
irritated  by  the  presence  of  matter  which  it  is  unable  to  send 
forward,  evacuated  only  partially  by  an  unnatural  and  highly 
excited  retrograde  action,  it  becomes  large,  thick  in  its  coats, 
strong  in  its  muscular  fibres,  and  greatly  inflamed,  till  it  ter- 
minate at  last  in  gangrene.^ 

The  unusual  excitement  of  the  muscular  fibres  produces  a 
very  curious  effect  in  the  intus-susceptio,  or  the  slipping  of  one 
portion  of  the  gut  within  another.  This  maybe  done  by  ap- 
plying acrid  matter  to  the  intestines  of  living  animals  ; and  I 
have  no  doubt  that  it  has  been  produced  by  giving  purges  too 
strong  and  stimulating  in  cases  of  obstruction  of  the  bowels. 
By  the  contractions  of  the  muscular  coat  greatly  excited,  the 
intestine  is  not  only  diminished  in  diameter  so  as  to  resemble 
an  earth-worm, f but  in  length  also.  This  great  contraction  of 
the  outer  coats  accumulates  the  vascular  and  villous  coat  as  if 
into  a heap  ; which  from  the  compression  of  the  muscular  coat 
is  lorced  into  the  neighbouring  relaxed  portion.  This  first  step 
leads  only  to  a succession  of  actions  ; for  the  fibres  of  the  re- 
laxed or  uncontracted  part,  sensible  to  the  presence  of  this  ac- 
cumulated and  turgid  villous  coat,  contracts  in  succession  so  as 
to  draw  a part  of  the  contracted  gut  within  the  relaxed  portion. 
If  the  irritation  is  done  away  or  ceases  quickly,  as  in  the  ex- 

* Haguenot  gives  an  experiment  illuftrating  the  caufe  of  ileus.  He  tied  a liga- 
ture about  the  intcftine  of  a cat,  and  found  no  antiperiftaltic  motion  excited. 
This  is  not  wonderful  ; it  is  the  excitement  arifing  from  matter  within  the  gut,  to 
which  there  is  no  exit,  and  not  the  ftridture  of  it,  which  is  the  caufe  of  the  violent 
fymptocns  — A cafe  in  the  Mufeum  will  give  the  young  ftudent  a corredt  judgment 
on  this  fuhject. 

t See  Haller’s  Experiments  ; and  “ DilTedlions  of  the  Atrophia  Ablactatorum 
with  plates ; by  Dr.  Cheyne. 

Vol.  IV.  G 


50 


01'  THE  SMALL  INTESTINES. 


periments  on  animals,  another  turn  of  the  intestine  coming 
into  play  distends  this,  and  undoes  the  intus-susceptio.  But 
if  the  cause  continues,  the  intus-susceptio  is  continued  ; the 
included  part  of  the  gut  is  farther  forced  into  the  other.  By 
these  means  the  vessels  going  to  the  included  part  are  inter- 
rupted ; the  villous  coat  swells  more  and  more  ; and  several 
ieet  of  the  upper  portion  of  the  intestine  is  often  in  this  wa)' 
swallowed  down.  It  is  not  however  in  the  natural  course 
downward  that  this  preternatural  action  always  proceeds  ; for, 
as  the  excitement  is  violent  and  unlike  the  usual  stimulus  of 
food,  and  as  we  know  that  an  unusual  excitement  is  very  apt 
to  cause  an  inverted  action,  it  often  happens  that  the  intus- 
susception is  formed  by  the  lower  portion  of  the  gut  included 
in  the  upper  part. 

VASCULAR  COAT. 

This  third  coat  of  the  intestines,  or  what  is  commonly  called 
the  nervous  coat,  is  a stratum  of  cellular  membrane  in  which 
the  vessels  of  the  gut  are  distributed.  It  might  with  equal 
propriety  be  called  the  cellular  coat  ; and  is  indeed  what  some 
anatomists  have  called  the  third  cellular  coat.  By  inverting 
the  gut  and  blowing  strongly  into  it,  the  peritoneal  coat  cracks 
and  allows  the  air  to  escape  into  this  coat  ; which  then  swells 
out,  demonstrating  its  structure  to  be  completely  cellular. ^ 
Its  use  evidently  is  to  suffer  the  arteries,  veins,  and  lymphatics 
to  be  distributed  to  such  a degree  of  minuteness  as  to  prepare 
them  for  reflection  into  the  last  and  innermost  coat,  and  for  en- 
tering into  the  structure  of  the  villi : for  they  come  to  the  ex- 
tremity of  the  mesentery  as  considerable  branches,  but  forming 
in  this  coat  a uniform  texture  of  vessels,  their  extreme 
branches  are  finally  distributed  to  the  inner  coat.  This  is  the 
coat  in  which,  in  some  parts  of  the  intestines,  little  glands  of 
criptas  are  lodged. 

VILLOUS  COAT. 

The  most  curious  part  of  the  structure  of  the  intestines  is 
the  villous  or  inner  coat  ; for  by  its  organization  is  the  chyle 
separated  from  the  general  mass  of  matter  in  the  bowels,  and 
carried  into  the  system  of  vessels.  To  this  all  we  have  been 
describing  is  merely  subservient. 

The  villous  coat  has  a soft  fleecy  surface  ; and  being  of 

* An  experiment,  to  which  Albinus  attaches  much  importance.  See  alfo,  in 
the  Acad,  de  Bologna,  a paper  by  Mr.  D.  G.  Galeati  on  the  flelhy  coat  of  the 
ftomach  and  inteftine6. 


OF  THE  SMALL  INTESTINES. 


51 


greater  extent  than  the  other  and  more  outward  coats,  it  is 
thrown  into  circular  plaits  which  hang  into  the  intestine,  taking 
a valvular  form.  They  have  the  name  of  valvule  conni- 
ventes.  Some  of  them  go  quite  round  the  inside  of  the  in- 
testine ; others  only  in  part.  They  are  of  larger  or  smaller 
extent  in  different  parts  of  the  canal : for  example  ; they  begin 
a very  little  way  from  the  lower  orifice  of  the  stomach  irregu- 
larly, and  tending  to  the  longitudinal  direction  ; further  down 
they  become  broader,  more  numerous,  and  nearly  parallel  ; 
they  are  of  greater  length,  and  more  frequent  in  the  lower 
part  of  the  duodenum  and  upper  part  of  the  jejunum. — > 
These  valvular  projections  have  their  edges  quite  loose  and 
floating  in  the  canal ; and  from  this  it  is  evident  that  they  can 
have  no  valvular  action.  Their  use  is  to  increase  the  surface 
exposed  to  the  aliment ; to  enlarge  the  absorbing  surface  ; and 
at  the  same  time  to  give  to  it  such  an  irregularity  that  the  chyle 
may  lodge  in  it  and  be  detained.*  Into  the  structure  of  these 
plicae  of  the  villous  coat,  the  vascular  or  cellular  coat  enters, 
and  generally  in  the  duplicature  a small  arterial  and  venous 
trunk  will  be  observed  to  run.  That  these  plicae  are  formed 
chiefly  by  the  laxity  of  the  connection  and  the  greater  relative 
extent  of  the  inner  coat,  is  apparent  upon  inverting  the  gut, 
and  insinuating  a blow-pipe  under  it,  for  then  you  may  distend 
the  cellular  substance  of  the  vascular  coat  so  as  entirely  to  do 
away  the  valvulae  conniventes. 

The  pile  or  lanuginous  surface  from  which  this  coat  has  its 
name,  is  to  be  seen  only  by  a very  narrow  inspection,  or  with 
the  magnifying  glass.  It  is  owing  to  innumerable  small  fila- 
ments which  project  from  the  surface,  like  hairs  at  first  view, 
but  of  a flat  or  rounded  figure  as  the  state  of  fulness  and  ex- 
citement or  depletion  shows  them.  They  consist  (as  appears 
by  the  microscope)  of  an  artery  and  vein,  and  lacteal  or  ab- 
sorbing vessels,  and  to  these  we  may  surely  add  the  extremity 
of  the  nerve.  They  have  a cellular  structure  ; they  are  ex- 
quisitely sensible  ; and,  when  stimulated  by  the  presence  of 
fluids  in  the  intestines,  are  erected,  and  absorb  the  chyle. 
They  are  the  extremities  of  the  lacteal  absorbing  system,  and 
their  structure  would  seem  to  be  subservient  to  the  absorption 
by  the  mouth  of  the  lacteal  vessel.f 

But  the  surface  of  this  coat  is  not  only  an  absorbing  one,  it 

* “ Superficies  intern se  hujus  tunicx  ad  menfuram  geometricam,  aliquoties  in- 
tegumentorum  communium  fuperficiem  amphtudine  fuperat.”  Soemmering,  vol. 
vi.p.  a95. 

t See  further  of  their  ftru&ure  under  the  title  of  the  Lacteal  and  Lym- 
phatic System,  in  this  volume,  where  the  fubjeft  of  abforption  and  the 
itriufture  of  the  villi  is  treated. 


52 


OF  THE  GREAT  INTESTINES. 


also  pours  out  a secretion : and  indeed  it  is  as  a secreting  sur- 
face, upon  wh;ch  medicines  can  act,  that  it  is  to  us  one  of  the 
most  power lul  means  of  acting  upon  the  system  in  disease. 
The  fluid  which  is  supplied  by  the  surface  of  the  intestines  is 
called  the  liquor  intericus  ; a watery  and  semipellucid  fluid, 
resembling  the  gastric  fluid.  This  fluid,  physiologists  have 
affected  to  distinguish  irom  the  mucous  secretion  of  the  glands 
of  the  inner  surlace  of  the  intestines  ; but  it  is  impossible  te 
procure  them  separate.* 

GLANDS. 

Anatomists  have  observed  small  mucous  glands  seated  in 
the  cellular  membrane,  of  the  intestines, f the  ducts  of  w'hich 
they  describe  as  opening  on  the  villous  surlace  oi  the  intestines. 
They  are  seen  as  little  opaque  spots,  when  the  intestine  is  cut 
in  its  length  and  held  betwixt  the  eye  and  the  light.  They 
have  been  chiefly  observed  in  the  duodenum  ; few  of  them  in 
the  general  tract  of  the  small  intestines.  Little  collections  or 
agmina  are  observed,  which  increase  in  frequency  toward  the 
extremity  of  the  ileon.  It  is  natural  to  suppose  that  as  the 
contents  of  the  intestines  become  in  their  descent  more  acrid 
and  stimulating,  there  will  be  a more  copious  secretion  of  mu- 
cus in  the  lower  intestines  lor  the  defence  of  the  villous  coat. 


SECTION  IV. 


OF  THE  GREAT  INTESTINES. 

The  great  intestines  form  that  part  of  the  intestinal  canal 
which  is  betwixt  the  extremity  of  the  ileon  and  the  anus. 
They  differ  essentially  from  the  small  intestines  in  their  size^ 
form,  and  general  character  ; and  in  the  texture,  or  at  least  in 
the  thickness  of  their  coats. 

The  great  intestine,  beginning  on  the  right  side  of  the  belly, 

* It  lias  been  fuppbfed  that  the  fluids  excreted  from  the  furface  of  the  inteflines 
were  iurnifhed  by  very  minute  foramina  (which  are  vifible  by  particular  prepara- 
tion) in  the  interfticc6  ot  the  villi.  See  the  letter  of  Malpighi  to  the  Royal  So- 
ciety of  London  on  the  Fores  of  the  Stomach  ; and  the  paper  by  M.  Galeati  in  the 
Bologna  tranfadtions  on  the  Inner  Coat,  which  he  calls  the  Cribriform  Coat. 
Thefe  pores,  according  to  Galeati,  are  vifible  through  the  whole  tradl  of  the 
canal,  and  particularly  in  the  great  inteflines. 

f Peyruf.  Biblio.  Manget.  Brunnerus  de  glanaulis  duodeni.  Wepfer,  Mor- 
gagni, &c.  Thefe  he  fuppofed  additional  pancreatic  glands- 


OF  THE  GREAT  INTESTINES. 


53 


rises  before  the  kidney  ; passes  across  the  upper  part  of  the 
belly,  under  the  liver,  and  before  or  under  the  stomach.* * * § 
Then  making  a sudden  angle  from  under  the  stomach  and 
spleen,f  h descends  into  the  left  iliac  region.  Here,  making  a 
remarkable  turn  and  convolution,  it  descends  into  the  pelvis 
by  a curve  running  in  the  hollow  of  the  sacrum. 

The  great  intestines  are  accounted  to  be  about  seven  feet  in 
length,  and  to  bear  a relation  to  the  small  intestines  as  five  to 
twenty- five. 

The  natural  division  of  this  portion  of  the  intestine  is  into 
the  coecum,  colon,  and  rectum.^ 

VALVULA  COLI. 

The  extremity  of  the  intestinum  ileon  enters  as  it  were  into 
the  side  of  the  great  intestine  at  an  angle.§  And  here  there 
is  a valvular  apparatus  formed  by  the  inner  membrane  of  the 
gut,  which,  more  than  any  other  circumstance,  marks  the 
distinction  betwixt  the  small  and  great  intestines  ; for  as  the 
effect  of  this  valve  is  to  prevent  the  regurgitation  of  the  feces 
into  the  small  intestines,  it  marks  sufficiently  the  nature  of  the 
change  produced  on  the  ingesta  in  their  passage  through  the 
small  intestine,  and  how  unfit  in  their  acrid  and  putrescent 
state  they  are  to  be  longer  allowed  lodgment  there. 

Upon  opening  the  caput  coli,  or  lower  part  of  the  colon,  on 
the  right  side,  and  examining  the  opening  of  the  ileon  into  it, 
we  see  a slit  formed  betwixt  two  soft  tumid  plicse  of  the  inner 
membrane  of  the  gut : the  one  of  these  is  superior  ; the  other 
inferior.  They  are  soft,  and  moveable,  and  seem  scarcely 
calculated  for  a valvular  action.  But  there  is  little  doubt  that 
when  the  great  gut  is  distended  or  in  action,  they  are  calculated 
to  resist  the  retrograde  passage  of  the  feces  into  the  ileon.  In 
the  oblong  opening  of  the  ileon,  and  in  the  broadness  of  the 
valvular  membranes,  there  is  considerable  variety.  The 
superior  valve  is  transverse,  smaller  and  narrower  than  the 
lower  one  ; the  lower  one  is  longer,  and  takes  a more  exten- 
sive curve : and  sometimes  the  lower  one  is  so  remarkably 
larger  than  the  upper  valve,  that  it  gives  a great  degree  of  ob- 
liquity to  the  insertion  of  the  ileon  into  the  colon,  so  as  to  ap- 

* This  turn  cf  the  colon  from  the  right  acrofs  the  belly  is  flexura  prima,  fuperior 
dextra  hepatica  Soemmering. 

f Flexura  fecunda,  fuperior  finiftra  lienalis. 

| Some  authors  divide  the  great  intefline  into  fix  parts,  enumerating  the  coecum  ; 
pars  vermiformis ; the  right ; the  left ; and  the  tranfverfe  colon  ; and  the  laft  part 
or  redlum. 

§ Of  the  entering  of  the  final!  intefline  into  the  greater,  fee  Morgagni  Ad- 
verfar.  iii.  Ahimad.  xi. 


OF  THE  GREAT  INTESTINES. 


5^ 

proach  to  that  structure  which  we  see  in  the  entrance  of  ducts, 
as  the  biliary  duct  into  the  intestine,  or  the  ureter  into  the 
bladder.  At  the  extremities  of  these  valves  they  coalesce  and 
run  into  the  common  transverse  folds  of  the  colon  : and  this  is 
what  Morgagni  has  called  the  fraena.  At  this  place  of  union 
of  the  ileon  and  colon  the  longitudinal  muscular  fibres  of  the 
ileon  are  mingled  and  confounded  with  the  circular  fibres  of  the 
colon.*  The  circular  muscular  fibres  certainly  enter  so  far 
into  the  composition  of  the  valve,  that  they  embrace  the  mar- 
gin, and,  by  contracting  during  life,  must  make  the  experi- 
ments on  the  action  of  this  valve  in  the  dead  body  less  decisive 
than  they  would  be  were  we  certain  that  this  valve  acts  on 
principles  strictly  mechanical. 

The  discovery  of  the  valve  of  the  colon,  and  which,  from 
its  action  in  guarding  the  ileon,  might  rather  be  called  the  valve 
of  the  ileon,  has  been  claimed  or  attributed  to  many  anato- 
mists, chiefly  to  Varolius,  Bauhin,  and  Tulpius  ; and  it  some- 
times receives  the  name  of  the  two  latter  anatomists. 

C CECUM. 

We  have  seen  that  the  ileon  is  inserted  into  the  side  of  the 
colon  : now  that  portion  of  the  gut  which  is  below  this  union 
of  the  ileon  is  a round  or  slightly  conical  sac,  from  two  to  three 
inches  in  length.  It  is  attached  by  cellular  membrane  to  the 
iliacus  internus  muscle.  It  is  not  a regular  sac,  but  is  divided 
into  large  cells  like  those  in  the  rest  of  the  colon,  and  has  con- 
siderable varieties  in  different  subjects. 

PROCESSUS,  SEU  APPENDIX  VERMIFORMIS. 

There  is  appended  to  the  crecum  a small  gut,  also  blind  ; 
but  bearing  no  relation  in  size  or  in  figure  to  any  part  of  the  in- 
testinal canal.  This  gut,  from  its  smallness  and  twisted  ap- 
pearance, like  the  writhing  of  an  earthworm,  has  received  the 
name  of  vermiformis.  It  is  somewhat  wider  at  the  connec- 
tion with  the  great  intestine,  and  stands  off  obliquely,  so  that 
sometimes  its  inner  membrane  takes  the  form  of  a valve.f  It 
scarcely  ever  is  found  containing  faeces,  but  only  a mucus  ex- 
creted from  its  glands.  In  the  foetus  the  appendix  vermiformis 
is  comparatively  much  larger,  its  base  wider  ; upon  the  whole, 
more  conical,  and  containing  meconium  ; and  in  the  young 
child  it  often  contains  faeces. 

* Window. 

t Morgagni.  M.  I.aur.  Bonazzoli  in  the  Acad,  of  Bologn#. 


OF  THE  GREAT  INTESTINES. 


GREAT  DIVISIONS  OE  THE  COLON. 

The  great  divisions  of  the  colon  (which  I conceive  it  neces- 
sary to  enumerate,  chiefly  with  a view  to  the  accurate  descrip- 
tion of  the  seat  of  disease)  are  these:  First,  the  right  divi- 
sion of  the  colon  rises  irorn  the  insertion  of  the  ileon,  and 
from  that  part  of  the  great  intestine  which  is  tied  down  by  the 
peritoneum  and  cellular  membrane,  and  ascends  on  the  right 
side  of  the  small  intestines,  until  it  gets  under  the  margin  of 
the  liver,  and  in  contact  with  the  gall-bladder.  Of  course, 
this  part  will  be  found  to  take  some  considerable  varieties  in 
its  form,  depending  upon  its  state  of  distention. 

THE  TRANSVERSE  COLON.^ 

The  transverse  colon  is  that  part  of  the  great  intestine  which 
often  takes  a course  directly  across  the  belly,  but  which  gene- 
rally forms  an  arch  before  or  immediately  under  the  stomach. 
When  this  part  of  the  colon  however  is  much  distended,  being 
at  the  same  time  held  down  by  the  mesocolon,  its  angular 
turns  reach  under  the  umbilicus,  nay  even  to  the  pelvis.  For 
the  varieties  in  the  situation  of  this  intestine  and  the  viscera  in 
general,  see  Morgagni  Adversar.  Anat.  ii.  Animadver.  ii. 

The  left  or  descending  colon  is  short  : for  between  the 
point,  where  the  colon  begins  to  bend  down  on  the  left  side,  and 
those  violent  turns  which  it  takes  before  terminating  in  the 
rectum,  is  but  a short  space.  It  is  here  attached  to  the  dia- 
phragm and  psoas  muscle. 

The  sigmoid  flexure  of  the  colonf  is  formed  by  a narrow- 
ing and  contraction,  and  closer  adhesion  of  the  gut  to  the 
loins  below  the  left  kidney,  and  to  the  cup  of  the  ileum  by  the 
peritoneum,  which  seems  to  have  the  effect  of  throwing  it  into 
some  sudden  convolutions.  The  colon  then  terminates  in  the 
rectum. 

peculiarities  in  the  c6lon  distinguishing  it  from 
the  small  intestines. 

The  coats  of  the  great  intestines  are  the  same  in  number  and 
in  structure  with  those  of  the  small  intestines  ; but  they  are 
thinner  and  more  difficult  to  be  separated  by  dissection.  The 
villi  of  the  inner  coat  are  smaller  ; the  mucous  glands  or  folli- 

* Colo v traksversdm.  Zona  Colt. 

From  its  refembling  the  Roman  S. 


56 


OF  THE  GREAT  INTESTINES. 


cules  are  sometimes  very  distinct ; and,  lastly,  the  muscular 
fibres  have  some  peculiarities  in  their  arrangement.  The 
most  characteristic  distinction  in  the  general  appearance  of  the 
great  and  small  intestines,  is  the  notched  and  cellular  appear- 
ance of  the  former.  The  cells  of  the  colon,  being  formed  be- 
twixt the  ligamentous-like  stripes  which  run  in  the  length  of 
the  gut,  have  a regular  three-fold  order.  These  cells  give 
lodgment  to  the  feces  ; retain  the  matter;  and  prevent  its  rapid 
descent  or  motion  to  the  rectum.  Here  the  fluids  are  still  more 
exhausted,  and  the  feces  take  often  the  form  of  these  cells. 
When  the  great  intestines  are  torpid,  and  inert  in  their  mo- 
tions, the  faeces  remain  too  long  in  the  cells  of  the  colon,  and 
become  hard  balls  or  scibulse.  But  when  in  this  state  of 
costiveness  the  intestines  are  excited  by  medicine,  not  only  is 
the  peristaltic  motion  of  the  intestines  increased,  but  the  ves- 
sels pour  out  their  secretions,  loosening  and  dissolving  the 
scibufe.* 


MUSCULAR  COAT. 

The  ligamentous-like  bands  of  the  colon  form  three  fasciculi 
running  in  the  length  of  the  gut : one  of  these,  obscured  by 
the  adhesion  of  the  omentum,  is  not  seen  without  dissection  ; 
and  the  other  is  concealed  bv  the  mesocolon. f These  bands  are 
formed  by  the  longitudinal  fibres  of  the  gut,  being  concentrated 
into  fasciculi,  and  not  uniformly  spread  over  the  general  sur- 
face, as  in  the  small  intestines  : and  being  at  the  same  time 
more  firmly  connected  with  the  peritoneal  coat,  they  give  the 
appearance  outwardly  of  ligament  more  than  of  muscular 
fibres.^  The  inner  or  circular  muscular  fibres  of  the  great  in- 
testines are  like  those  of  the  small  intestines,  uniformly  spread 
over  their  surface,  and  are  stronger  than  those  of  the  latter. 

Faeces.  That  the  food  digested,  in  part  absorbed,  and  its 
fluids  exhausted,  becomes  feces  in  its  progress  through  the  in- 
testines, will  be  universally  allowed  : but  how  much  of  the 
excrementitious  matter  in  the  colon  is  a human  secretion  is  not 
equally  attended  to.  Men  who  have  died  of  want,  and  men. 
exhausted  by  long  fever  or  other  distress,  and  who  did  not  or 
were  incapable  of  taking  nourishment,  have  had  discharges  of 
feces ; and  feces  are  found  in  their  intestines  upon  dissection. 

* See  note  of  the  pores  of  the  inteflines. 

f Stratum  liberum,  ftratum  omentale  & tertium  Mefocolicum.  Soemmer.  § 
ccxxx. 

} See  Morgagni.  See  alfo  Galeati  on  the  flefhy  coat  of  the  ftomach  and  intes- 
tines, in  the  Memoirs  of  the  Acad,  of  Bologna. 


OF  THE  GREAT  INTESTINES, 


of 


The  foetus  has  the  intestines  filled  with  meconium.'*  The 
effect  of  a purge  is  not  only  to  stimulate  the  intestines  to  throw 
ofF  their  contents,  but  the  inner  secreting  surfaces  pour  out 
their  fluids.  The  surface  of  the  intestines  is  not  only  calcu- 
lated to  absorb  nourishment,  and  capable  of  throwing  off  the 
fluids  from  the  system,  like  the  kidneys  in  secreting  the  urine, 
but  it  seems  destined  in  a particular  manner  to  carry  off  the 
earthy  parts  of  the  body,  which  in  the  circle  of  actions  is  al- 
ternately undergoing  renovation  and  de'cay.  Thus  the  fieces 
consist  of  the  food  and  chvme,  which  has  not  been  converted 
into  chyle  and  absorbed,  but  which  has  been  decomposed,  and 
has  entered  into  new  combinations  ; it  is  united  to  part  of  the 
bile,  which  has  also  been  decomposed  ; to  the  secretion  of  the 
pancreas  ; to  the  secretion  of  the  immense  extent  of  surface  of 
the  intestines  ; and  many  substances  are  found  in  the  excre- 
ments which  did  not  exist  in  the  food.  From  the  same  sources 
(viz.  the  secretions  poured  into  the  intestinal  canal,  or  directly 
from  its  surface)  are  formed  concretions,  often  of  an  enor- 
mous size  ; often  distinct  from  the  nature  of  the  more  common 
biliary  secretions  ;f  and  sometimes  these  earthy  deposits  enter- 
ing into  the  composition  of  the  fasces,  give  to  them  a stony 
hardness. 

RECTUM. 

The  rectum  forms  the  last  division  of  the  great  intestines  j. 
and  I know  no  better  proof  of  the  impracticability  of  altering 
the  names  in  anatomy  than  this,  that  anatomists  have,  in  almost 
every  age,  insisted  on  the  impropriety  of  calling  this  gut, 
which  answers  in  its  shape  to  the  curve  of  the  sacrum,  a 
straight  gut  ; and  yet  always,  and  to  the  present  day,  it  is 
rectum. 

From  the  last  turns  of  the  colon,  called  sigmoid,  the  gut  is 
continued  over  the  promontory  of  the  last  vertebra  and  sacrum 
(a  little  to  the  left  side,)  and  falls  into  the  pelvis.  It  runs 
down,  in  a l curved  direction,  betwixt  the  sacrum  and  bladder 
of  urine.  In  the  upper  part  it  is  covered  by  the  peritoneum, 
and  has  its  fatty  appendages  like  the  colon,  but  less  regular  ; 
and  sometimes  the  fat  merely  deposited  under  the  peritoneal 
coat.  It  is  tied  down  by  the  peritoneum,  in  form  of  meso- 
rectum  ; but,  deeper  in  the  pelvis,  it  loses  the  peritoneum 
(which,  as  wre  have  said,  is  reflected  up  upon  the  back  of  the 
bladder,  and  forms  here  lateral  folds,)  and  the  rectum  is  c©n- 

* See  Haller  Phis.  Elem.  tom.  vii.  feet.  6.  § 3. 

f Haller  loc.  cit. 

Vol.  IV.  H 


58 


OF  THE  LIVER. 


nected  with  the  lower  part  of  the  bladder  and  vesiculse  semi- 
nales  by  cellular  membrane.  In  women,  the  muscular  fibres  of 
the  rectum  and  vagina  are  intimately  connected.^ 

The  muscular  coat  of  the  rectum  is  particularly  strong.  The 
fleshy  bands  of  the  colon,  spreading  out,  are  continued  down 
upon  the  rectum  in  an  uniform  sheath  of  external  longitudinal 
fibres.  The  circular  fibres  of  this  part  of  the  gut  are  also  par- 
ticularly strong;  and  towards  the  extremity,  appearing  in  still 
stronger  fasciculi,  they  obtain  the  name  of  sphincter,  of  which- 
three  are  enumerated  : and  this,  to  distinguish  it  from  the 
others,  is  called  the  intestinal  or  orbicular  sphincter. 

The  internal  coat  of  the  rectum  does  not  deserve  the  name 
of  villous,  nor  of  papillaris.  Its  surface  is  smooth,  and  there 
are  often  distinctly  seen  little  foramina  like  the  mouths  of  ducts 
or  follicules,  in  part  the  source  of  the  mucous  discharge,  which 
is  sometimes  poured  out  from  this  gut.  Towards  the  anus  the 
fold  becomes  longitudinal,  and  terminates  in  the  notched-lik.e 
irregularities  of  the  margin. 


GHAP.  III. 


OF  THE  SOLID  OR  GLANDULAR  VISCERA  OF 
THE  ABDOMEN. 

SECTION  I. 

OF  THE  LIVER. 

OF  ITS  SEAT,  AND  CONNECTIONS  BY  LIGAMENTS,  AND  OF 
THE  DIVISIONS  APPARENT  ON  ITS  SURFACE. 

Our  attention  is  now  naturally  drawn  to  the  liver,  as  it 
hoids,  in  so  eminent  a degree,  the  sovereignty  over  the  mo- 
tions of  the  intestinal  canal,  and  as  it  is  so  strictly  connected 


* WinfloW: 


OF  THE  LIVER. 


59 


with  it  by  its  system  of  vessels,  and  by  its  functions.  The 
liver  is  the  largest  viscus  in  the  body,  and  as  in  its  size  and 
proportion  to  the  whole  body  it  is  great,  so  are  its  connections 
in  other  respects  with  the  whole  system  very  intimate.  This  is 
particularly  evident  in  the  diseases  of  the  liver,  and  was  the 
cause  of  the  ancients  ascribing  to  it  so  eminent  a place  in  the 
ceconomy. 

Function  of  the  liver. — In  all  ages  authors  have  paid 
particular  attention  to  the  liver,  and  have  exercised  their  inge- 
nuity in  giving  various  explanations  of  its  function.  The  an- 
cients made  it  the  supreme  director  of  the  animal  system. 
They  supposed  that  they  could  trace  the  nutritious  fluids  of  the 
intestines  through  the  meseraic  veins  into  the  porta  and  into  the 
liver,  and  that  it  was  there  concocted  into  blood.  From  the 
liver  to  the  right  side  of  the  heart  they  found  the  cava  hepatica, 
carrying  this  blood  formed  in  the  liver  to  the  centre  of  the 
system  : and  through  the  veins  they  supposed  the  blood  to  be 
carried  to  the  remote  part  of  the  body. 

The  liver  is  the  largest  glandular  body  of  the  whole  system. 
Its  use  is  to  secrete  the  bile,  which  is  carried  into  the  intestines, 
and  performs  there  an  essential  action  on  the  food  while  passing 
in  the  tract  of  the  intestines. 

Seat  of  the  liver. — The  liver  is  seated  in  the  upper 
part  of  the  abdomen,  under  the  margin  of  the  ribs,  and  to- 
wards the  right  side,  or  in  the  right  hypochondrium.  In  the 
foetus  it  occupies  more  of  the  left  side  than  it  does  in  the  adult. 
Indeed  it  is  nearly  equally  balanced  in  the  foetus,  but  the  older 
the  animal  (or  at  least  for  the  five  first  years)  the  greater  will  be 
the  proportion  of  it  found  lodged  in  the  right  side. 

Without  going  into  the  more  minute  subdivisions  of  this 
viscus,  we  may  observe,  that  it  is  more  uniform,  and  smooth, 
and  convex  on  the  upper  surface  ; on  the  lower,  more  irregu- 
larly concave.  Its  upper  surface  is  applied  in  close  contact  to 
the  concavity  of  the  diaphragm,  and  in  the  foetus  its  margin  is 
in  contact  with  the  abdominal  muscles,  because  it  falls  lower 
than  the  margin  of  the  ribs.  Its  lower  and  concave  surface 
receives  the  convexity  of  the  stomach,  duodenum,  and  colon. 
In  a healthy  adult  subject  the  liver  does  not  extend  from  under 
the  margin  of  the  ribs,  unless  near  the  pit  of  the  stomach,  but 
in  the  foetus  and  child  it  is  much  otherwise.  In  a foetus  of  the 
third  and  fourth  month  the  liver  almost  fills  the  belly;  it 
reaches  to  the  navel,  covers  the  stomach,  and  is  in  contact 
with  the  spleen.  After  the  seventh  month  other  parts  grow 
with  a greater  rapidity  in  proportion.  Indeed  some  have  af- 
firmed, that  the  liver,  or  at  least  the  left  lobe,  actually  de- 


m 


®F  THK  LITER. 


creases  towards  the  time  of  birth.*  But  from  this  time  to  the 
advance  to  manhood  the  chest  becomes  deeper  ; the  sternum 
is  prolonged  ; and  the  diaphragm  becomes  more  concave  ; so 
that  the  liver  retires  under  the  margin  of  the  ribs,  and  its  mar- 
gin on  the  left  side  in  the  adult  reaches  no  farther  than  to  the 
(Esophagus.  When  however  the  liver  becomes  schirrous  and 
enlarged,  its  hard  margin  comes  down  so  as  to  be  felt  through 
the  abdominal  paries  under  the  border  ofthe'chest.  This  en- 
largement of  the  liver,  and  consequent  descent  of  its  margin, 
is  to  be  felt  more  easily  by  grasping  the  integuments  of  the 
belly,  as  if  you  expected  to  lift  up  the  acute  edge  of  the  liver, 
than  by  pressing  with  the  point  of  the  finger.  By  this  means 
we  shall  be  sensible  of  the  elasticity  and  softness  below  the 
liver,  and  of  the  resistance  and  firmness  of  the  margin  of  it. 
The  ply  sician,  however,  should  not  forget,  that  the  depres- 
sion of  the  diaphragm,  and  consequent  protrusion  of  the  liver 
by  disease  in  the  thorax,  gives  the  feeling  of  an  enlargement 
and  hardening  of  the  liver.  The  left  great  division  of  the  liver 
is  perhaps  as  often  diseased  and  enlarged  as  the  right,  in  which 
case  it  is  more  difficult  to  ascertain  it  by  examination,  and  it 
must  be  learnt  from  other  circumstances  besides  the  actual 
touch. 

Neither  should  a physician  be  ignorant,  that  by  suppuration 
in  the  lungs,  and  consequent  rising  of  the  diaphragm,  the 
liver  is  elevated  considerably,  so  as  to  retire  farther  under  the 
protection  of  the  false  ribs.f 

M.  Portal,  by  running  stilettos  into  the  belly  of  the  subject 
as  it  lay  upon  the  table,  or  was  raised  into  the  perpendicular 
posture,  found  that  in  the  latter  posture  the  liver  shifted  two 
inches.  But  it  is  almost  superfluous  to  remark  concerning 
these  experiments,  that  they  are'  by  no  means  conclusive.  ■ In 
the  dead  body,  the  abdominal  muscles  are  relaxed  ; they  yield 
to  the  weight  of  the- viscera  ; and  the  diaphragm  is  pulled 
down  by  the  weight  of  the  abdominal  viscera.  The  margin 
of  the  liver  necessarily  falls  lower,  but  in  the  living  body 
there  is  a close  and  perfect  bracing  of  every  part  by  the  abdo- 
minal muscles  ; tlu-y  do  not  yield,  and  very  little  if  any  altera- 
tion can  take  place  in  the  situation  of  the  viscera. 

It  must  be  observed,  however,  that  a considerable  motion 
of  the  liver  is  the  effect  of  respiration,  and  of  the  action  of  the 
diaphragm.  This  motion  is  chiefly  on  the  back  part  of  the 
right  lobe  of  the  liver.  The  left  lobe  being  more  on  the  centre 
of  the  belly,  and  consequently  opposite  to  the  centre  and  less 

9 M.  Porta],  Acad,  de  Sciences,  1773. 

•j:  T hefe  obfervations  in  detail  belong  to  another  place. 


GF  THE  LIVER. 


6i 


moveable  part  of  the  diaphragm,  it  is  less  affected  by  the  respi- 
ration than  the  larger  right  lobe. 

LIGAMENTS  OF  THE  LIVER. 

The  peritoneum  is  reflected  in  such  a manner  from  the 
neighbouring  parts  upon  the  liver  as  to  form  membranes  re- 
ceiving the  name  of  ligaments.  It  has  been  explained,  how- 
ever, that  these  are  not  the  sole  support  of  this  viscus  ; and 
that  the  compression  of  the  surrounding  abdominal  muscles  is 
the  principal  support  o-f  the  liver,  as  it  is  of  the  other  viscera. 

The  broad  ligament*  of  the  liver  is  formed  by  two  la- 
mina of  the  peritoneum,  connected  by  their  cellular  mem- 
brane, descending  from  the  middle  of  the  diaphragm  and 
point  of  the  sternum  to  the  convex  upper  surface  or  dorsumf 
of  the  liver.  This  ligament  is  broadest  where  it  passes  down 
from  the  point  of  the  sternum  to  the  fossa  umbilicalis  ; but  as 
it  retreats  backward  it  becomes  narrower,  and  is  united  to  the 
coronary  ligament  near  the  passage  of  the  vena  cava.  This 
circumstance,  with  the  curve  which  it  naturally  takes  on  the 
surface  of  the  liver,  gives  it  the  shape  of  the  falx,  as  it  is 
formed  by  the  dura  mater. 

ligamentum  teres.  The  round  ligament  of  the  liver  is 
the  firmer  ligamentous-like  cord,  which  may  be  traced  from 
the  umbilicus  along  the  peritoneum  into  the  duplicature  of  the 
broad  ligament,  and  into  the  fossa  umbilicalis.  It  is  formed 
by  the  degenerated  coats  of  the  great  vein  which  brings  the 
florid  blood  from  the  placenta  into  the  veins  of  the  liver,  and 
from  thence  conveys  it  into  the  right  side  of  the  heart  of  the 

fcetus.f 

The  coronary  ligament  of  the  liver  is  formed  in  conse- 
quence of  the  attachment  of  the  liver  to  the  diaphragm.  The 
attachment  is  of  course  surrounded  by  the  inflection  of  the 
peritoneum  from  the  diaphragm  to  the  liver.  It  is  called  the 
coronary  ligament,  though  it  has  been  observed,  that  this 
attachment  of  the  liver  is  not  circular,  but  of  an  oval,  and 
very  oblong  shape.  It  appears,  that  it  is  this  close  adhesion  of 
the  liver  to  the  diaphragm,  which  is  the  occasion  of  the  sympa- 
thy of  the  diaphragm  in  disease  of  the  liver,  and  the  cause  of 
the  pain  felt  in  the  shoulder  and  neck  from  inflammation,  and 
suppuration  in  the  liver,  in  consequence  of  the  course  and  con- 
nections of  the  phrenic  nerve. 

The  lateral  ligaments  are  formed  by  the  peritoneum 

* Ligamentum  latum  fufpenforium,  falciforme. 

f See  Plate  I.  of  this  volume. 

| See  vol.ii.  p.  106,  and  Plate,  p.  107. 


62 


0F  THE  LIVER. 


continued  laterally.  The  right  lateral  ligament,  like  a mesen- 
tery, attaches  the  right  and  great  lobe  of  the  liver  to  the  dia- 
phragm, and  the  left  lateral  ligament  connects  the  left  lobe 
with  the  diaphragm,  and  with  the  oesophagus  and  spleen. 

FORM  AND  DIVISIONS  OF  THE  LIVER. 

The  liver  is  convex  and  smooth  on  the  upper  surface  ; con- 
cave and  more  irregular  on  the  lower  part  ; thick  and  massy 
behind  and  towards  the  right  side  ; but  anteriorly  and  toward 
the  left  side  it  is  thin,  and  has  an  acute  edge,  so  that  it  lies 
smooth  over  the  distended  stomach. 

Great  right  and  left  lobf.s  of  the  liver. — The 
first  great  division  of  the  liver  is  marked  on  the  convex  surface 
by  the  broad  ligament ; which  running  back  from  the  fossa 
umbilicalis  divides  it  into  the  two  great  lobes,  the  right  and 
left.  When  the  concave  surface  of  the  liver  is  turned  up,  we 
see  the  same  division  into  the  right  and  left  lobes  by  a fissure 
which  runs  backwards. 

It  is  on  this  lower  surface  of  the  liver  that  we  have  to  mark 
the  greater  variety  of  divisions  in  this  viscus.  Farther,  it  is 
on  the  right  lobe  that  those  eminences  are  to  be  observed 
which,  with  the  indentations  and  sulci,  give  some  intricacy  to 
this  subject. 

Lobulus  spigelii.* — The  lobulus  spigelii  is  betwixt  the 
two  greater  lobes,  but  rather  belonging  to  the  right  great  lobe. 
From  its  situation  deep  behind,  and  from  its  having  a particular 
papilla-like  projection,  it  is  called  lobulus  posterior,  or  papil- 
latus.  To  the  left  side  it  has  the  fissure  for  the  lodgment  of 
the  ductus  venosus  ; on  the  right,  the  fissure  for  the  vena 
cava  ; and  above,  it  has  the  great  transverse  fissure  of  the 
liver  for  the  lodgment  of  the  cylinder  of  the  porta  : obliquely 
to  the  right,  and  upwards,  it  has  a connection  with  the  lower 
concave  surface  of  the  great  lobe  by  the  processus  caudatus, 
which  Winslow  calls  one  of  the  roots  of  the -lobulus  spigelii. 
It  is  received  into  the  bosom  of  the  lesser  curve  of  the  stomach. 

Lobulus  caudatus. f — This  really  deserves  the  name  of 
processus  caudatus,  for  it  is  like  a process  of  the  liver,  stretch- 
ing downward  from  the  middle  of  the  great  right  lobe  to  the 
lobulus  spigelii.  It  is  behind  the  gall-bladder,  and  betwixt 
the  fossa  vense  portarum  and  the  fissure  for  the  lodgment  of  the 
vena  cava. 

* Lobulus  p ostcrior  —posticus— -pap  ell  at  us . 

f Processus  caudatus. 


OF  THE  LIVES. 


63 


Lobulus  Anonymus* * * §  is  the  anterior  point  of  the  great  right 
lobe  of  the  liver  : or  others  define  it  to  be  that  space  of  the 
great  lobe  betwixt  the  fossa  for  the  umbilical  vein  and  the  gall- 
bladder, and  extending  forward  from  the  fossa  for  the  lodg- 
ment of  the  porta,  to  the  anterior  margin  of  the  liver. 

Sulci,  and  depressions  of  the  liver. — On  the  lower 
surface  of  the  right  lobe  there  may  be  observed  two  slight  ex- 
cavations, formed  as  it  were  by  the  pressure  of  the  colon  and 
of  the  kidney.  On  the  lower  surface  of  the  left  lobe  there  may 
also  be  observed  depressions  answering  to  the  convexities  oi 
the  stomach  and  colon.  But  these  are  only  the  slighter  irregu- 
larities which  might  pass  unnoticed.  There  are,  besides 
these,  deep  divisions  which  pass  betwixt  the  lobes  and  lobuli, 
and  indeed  form  these  eminences. 

Umbilical  fissure.! — From  the  anterior  point  of  the  two 
lobes  there  passes  backwards  to  the  left  side  of  the  lobulus 
spigelii  a deep  fissure,  which  in  the  foetus  gives  lodgment  to  the 
umbilical  vein,  and  which  in  the  adult  receives  the  round  liga- 
ment, where  it  is  about  to  terminate  in  the  left  division  of  the 
vena  portae.  The  back  part  of  this  fissure  gives  lodgment  to 
the  ductus  venosus  in  the  foetus.  This  fissure  divides  the  liver 
into  its  two  right  and  left  divisions,  and  upon  the  right  side 
joins  the  transverse  fissure. 

The  transvi  rse  fissure  is  that  which  passes  above  the 
lobulus  spigelii,  and  lobulus  quadratus  ; the  processus  caudat- 
us,  and  the  lobulus  lobi  sinistri.  It  is  in  this  fissure  that  the 
great  transverse  division  of  the  vena  portte  lies. 

The  post  rior  fissure!  gives  lodgment  to  the  ductus 
venosus.  It  is  a division  in  the  posterior  margin  of  the  liver 
betwixt  the  left  lobe,  and  the  lobulus  spigelii,  and  great  lobe 
on  the  right.  Sometimes,  instead  of  the  fissure  or  sulcus, 
there  is  a canal,  as  it  were,  in  the  substance  of  the  liver. 

The  fourth  great  fissure,  is  that  for  the  lodgment  of  the 
vena  cava.  It  sometimes  is  called,  in  contradistinction  to  the 
last,  the  right  fissure,  or  the  fissura  vena;  cava.  It  is  a 
large  deep  division  betwixt  the  lobulus  spigelii  and  the  back 
part  of  the  right  lobe,  for  receiving  the  vena  cava  as  it  passes 
up  upon  the  spine. 

The  gall-bladder  being  sunk  in  the  substance  of  the  liver,, 
the  pit  or  excavation  which  receives  it  has  been  considered 
improperly  as  a fissure  or  fossa.§  There  likewise  occur  irre- 

* Lobulus  accessorius — anterior — quadratus. 

f Horizontal  Allure,  folia  longitudinalis,  longa  anterior. 

1 Or  fulcus  dudtus  venoA,  the  left  Allure. 

§ .It  is  generally  called,  fovea  ftllis , or  vallicula  •veftcnlaj cllea. 


64 


OF  THE  LIVER. 


gular  fissures  in  the  substance  of  the  liver,  which  are  like  the 
cuts  of  the  knife,  and  hold  no  regular  place. 

OF  THE  VESSELS  OF  THE  LIVER,  AND  OF  THE  CIRCULATION 
OF  THE  BLOOD  THROUGH  IT. 

There  belong  to  the  liver  five  distinct  systems  of  vessels  : 
these  are  the  vena  port*  ; the  arteria  hepatica  ; the  vena  cava 
hepatic*  ; the  lymphatics  ; and  the'  biliary  ducts.*  These, 
with  the  nerves,  form  a very  intricate  svstem  of  vessels,  but  a 
lesson  of  the  most  particular  importance  to  the  physician. 
Before  speaking  of  the  connections  which  these  vessels  consti- 
tute with  particular  parts,  or  with  the  entire  svstem,  we  shall 
take  a strictly  anatomical  view  of  their  origin  and  course. 

THE  VENA  PORTjE. 

This  vein  is  divided  into  two  parts  ; that  which  belongs  to 
the  intestines,  and  which,  ramifying  on  the  mesenterv,  receives 
the  blood  of  the  mesenteric  arteries  ; and  that  part  which 
branches  in  the  liver,  and  distributes  there  the  blood  which  it 
has  received  from  the  arteries  of  the  membranous  viscera. 
Even  from  this  division  we  see  that  the  vena  ports  has  a very 
particular  distribution  ; that  while  it  is  collecting  its  branches 
from  the  spleen,  stomach,  and  intestines,  like  the  veins  in  the 
other  parts  of  the  body,  into  a trunk,  this  trunk,  instead  of 
leading  directly  to  the  heart,  or  uniting  with  other  veins  in 
their  course  to  the  heart,  enters  the  liver,  and,  like  an  artery, 
spreads  into  minute  ramifications  ; hence  it  is  called  the  vena 
arteriosa.  It  resembles  an  artery  in  this  also,  that  it  has  no 
valves  like  other  veins. 

To  be  more  particular  ; the  vena  port*  takes  its  origin  from 
the  extreme  branches  of  the  cceliac,  upper  and  lower  mesen- 
teric arteries.  The  roots  of  the  port*  answering  to  these  ar- 
teries are  the  splenic  vein  ; the  gastro-epiploic  vein  which  runs 
upon  the  great  arch  of  the  stomach  ; the  mesenteric  vein  re- 
turning from  the  small  intestines  ; and  the  right  and  middle 
colic  veins,  and  internal  haemorrhoidal  vein  and  left  colic  return- 
ing upon  the  mesocolon.  These  answering  to  the  three  great 
branches  of  the  abdominal  aorta,  pass  obliquely  upward  in 
three  great  divisions,  and  unite  with  some  lesser  veins,  as  the 
coronary  and  smaller  veins  of  the  stomach,  and  pancreatico- 


* And  we  might  add,  the  arteries  of  the  outer  membrane  of  the  liver  which 
arife  from  the  internal  mammary,  phrenic,  epigaftric,  and  even  the  fpermatic 
arteries. 


OF  THE  LIVER, 


if 

duodenalis.  The  trunk  of  the  vena  portae  is  now  involved  in 
the  irregularly  reticulated  web  of  the  hepatic  vessels,  arteries, 
veins,  glands,  lymphatics,  nerves,  and  biliary  ducts,  with  their 
cellular  membrane.  It  passes  upward  somewhat  obliquely  to 
the  right ; and  enters  the  p.  rta*  or  the  sinus  betwixt  the  pro- 
cessus caudatus  and  lobulus  spigelii. 

V hen  the  vena  portae  has  entered  the  liver,  it  divides  into 
two  great  branches,  which  running  directly  transverse,  and  be- 
ing of  large  capacity,  are  sometimes  called  the  cylinder  of  the 
vena  portae.  Of  these  two  great  branches  ol  the  vena  portse 
within  the  liver,  the  right  is  greater  in  diameter,  but  shorter  :f 
it  ramifies  in  the  great  right  lobe  of  the  liver.  The  lelt  is  lon- 
ger considerably,  and  filling  the  transverse  fissure,  it  is  reflect- 
ed up  into  the  umbilical  or  horizontal  fissure,  and  is  given  to 
the  left  lobe,  to  the  upper  and  more  anterior  part  of  the  right 
lobe,  viz.  lobulus  anonymus,  and  to  the  lobulus  spigelii. 

The  minute  ramifications  of  the  vena  portae  every  where 
pervade  the  substance  of  the  liver,  and  inosculate  with  the 
veins  of  the  surface  belonging  to  the  peritoneal  coat.  The 
blood  of  the  vena  portae,  alter  secreting  the  bile,  is  received  in- 
to the  extremities  of  the  venae  cavae  hepatic^. 

ARTERIA  HEPATICA. 

For  the  course  of  this  artery  from  the  root  of  the  cceliac  ar- 
tery, to  its  entrance  into  the  liver,  see  vol.  ii.  p.  257,  and  259. 
The  arteria  hepatica  and  the  venae  portae  are  supported  by  the 
same  sheath,  the  lesser  vessel  encircling  the  greater,  like  a ten- 
dril. While  they  hat'e  distinct  functions,  both  terminate  in  the 
same  returning  veins  : that  is  to  say,  whether  we  admit  chat 
one  or  both  open  into  the  biliary  ducts,  yet  they  have  the  same 
relation  to  the  vense  cavae  hepaticae  which  the  arteries  of  the 
other  parts  of  the  body  have  to  their  returning  veins. 

VEN JE  CAVJE  HEPATIC.E. 

We  have  seen,  that  the  right  auricle  of  the  heart  is  close 
to  the  diaphragm  above,  and  that  the  liver  adheres  to  the  lower 
surface  of  the  diaphragm.  We  have  also  found  that  there  was 
a groove  in  the  back  part  of  the  liver  for  the  transmission  of 
the  venae  cavse  abdominalis.  Now  as  the  vense  cavse  ascend- 
ing from  the  lower  parts  of  the  body  to  the  heart  is  perforating 

* Sometimes  it  has  been  found  divided  before  entering  the  liver.  It  has  been 
alfo  found  to  divide  into  three  branches,  in  which  cafe,  fays  Haller,  two  go  to  the 
left  fide. 

i Into  this  branch  fometimes  the  vein  of  the  gall-bladder  entors- 

Vol.  IV.  I 


60 


OF  THE  LIVER. 


the  diaphragm,  it  is  joined  by  two  large  veins  from  the  liver, 
which,  from  their  size  and  form,  being  the  returning  veins  of 
the  liver,  are  termed  in  general  the  vena;  cavae  hepaticae.  These 
veins  sometimes  pierce  the  diaphragm  along  with  the  cavae 
abdominalis,  so  that  there  is  to  be  observed  one  large  perfora- 
tion in  the  diaphragm,  but  generally  they  pass  the  diaphragm 
close  to  the  great  vein,  but  so  that  there  are  three  openings  in 
the  diaphragm.  When  these  hepatic  veins  are  traced  into  the 
substance  of  the  liver,  they  are  seen  to  be  gathered  together 
from  all  parts  of  the  liver  in  two,  or  sometimes  three  great 
branches.  The  communication  betwixt  the  vena  portae  and 
the  venae  cavae  hepaticae  are  so  free,  that  several  anatomists 
have  imagined  a peculiar  and  more  immediate  communication 
of  their  branches  than  holds  in  other  parts  of  the  body  betwixt 
the  arteries  and  veins;  a circumstance  which  app'earedto  them 
the  more  necessary,  considering  the  lesser  impetus  with  which 
the  blood  flows  in  the  vena  portae  than  in  the  arterial  system. 


The  last  subdivision  of  the  substance  of  the  liver,  or  acini, 
as  we  shall  presently  find,  is  supplied  with  a branch  of  the  ve- 
nae port.e,  arteria  hepatica,  and  venae  hepaticae.  With  these 
there  is  also  seen  a minute  ramification  of  the  excretory  duct 
of  the  liver.  These  last  minute  branches  are  the  roots  of  the 

* Explanation  of  the  plate  of  the  g all-bladder . 

A The  gall-bladder. 

B The  cyftic  dudl. 

C The  hepatic  dudl. 

D The  common  du<5L 

E The  hepatic  artery. 

F The  cyftic  artery  coming  off  from  it. 


OF  THE  LIVER. 


67 


biliary  duct ; which  running  into  each  other,  form  trunks  re- 
sembling the  branches  of  veins,  and  which  attaching  them- 
selves to  the  vena  porta,  form  the  greater  trunks,  answering  to 
the  right  and  left  side  of  the  liver.  These  two  divisions  of  the 
hepatic  duct  approaching  each  other,  unite  (C),  while  they  are 
attached  to  the  right  branch  of  the  vena  porta.  Their  union 
constitutes  the  hepatic  duct,  or  ductus  choledochus. 

When  the  duct  of  the  liver  has  advanced  a little  way  from 
the  transverse  fissure,  it  is  joined  by  the  cystic  duct  (B),  or 
perhaps  we  should  rather  say,  considering  the  use  of  the  cystic 
duct,  that  it  is  reflected  from  it  at  an  acute  angle  to  the  right 
side.  The  ductus  c\rSTicus  is  much  smaller  than  the  hepatic 
duct ; and  is  somewhat  curved  in  the  direction  towards  its  ex- 
pansion into  the  gall-bladder  ; for  there  it  takes  a very  sudden 
turn  downward,  as  is  seen  in  the  marginal  plate. 

The  hepatic  duct,  after  being  joined  by  the  cystic  duct,  con- 
tinues its  course  under  the  name  of  ductus  communis  choledo- 
chus, or  common  duct.*  Now  become  somewhat  larger,  it 
takes  its  course  under  the  head  of  the  pancreas  to  the  back 
part  of  the  duodenum,  about  five  inches  from  the  pylorus. 

Before  it  enters  the  gut,  or  more  generally  while  included  in 
the  coats,  it  is  joined  by  the  pancreatic  duct.  Having  pierced 
the  muscular  coat,  it  runs  for  some  time  in  the  cellular  coat,  in 
the  length  of  the  gut,  and  then  opens  upon  the  eminence  of  a 
considerable  valvular  plica  of  the  inner  coat. 

This  hole  is  regularly  limited,  and  by  no  means  equal  to  the 
diameter  of  the  duct,  either  where  it  is  contained  within  the 
coats  of  the  gut,  or  in  its  course  from  the  liver  to  the  gut. 
Sometimes  the  hepatic  and  pancreatic  duct  open  by  distinct 
perforations. 

The  outer  coat  of  these  ducts  is  smooth  and  strong  ;f  within 
this  a cellular  and  nervous  coat  is  described,:}:  and  muscular 
fibres  imagined  ; but  the  inner  coat  is  worthy  of  attention.  It 
is  reticulated  in  such  away,  that  a probe  pushed  up  the  duct  is 
catched  by  their  valve-like  action. § 

GALL-BLADDER. 

We  have  already  noticed,  that  the  gall-bladder  is  attached  to 
the  lower  surface  of  the  right  lobe  of  the  liver,  and  partly  bu- 

* Dudlus  choledochus,  hepatico  cyftlcus,  (D.) 

f Although  this  coat  refills,  in  a confiderable  degree,  the  diftention  of  the  du<S, 
when  blown  into  or  injected,  yet  the  whole  are  fonietimes  fo  diftended  as  to 
admit  the  thumb.  But  this  is  rather  to  be  confidered  as  growth  and  enlarge- 
ment, than  diftention. 

f By  Haller. 

4 Thefe  1 have  feen  miftaken  for  adhial  obftructions. 


S8 


OF  THE  LIVER. 


ried  in  its  sinus  : it  has  sometimes  occurred  that  it  was  merely 
suspended  to  the  liver  by  a membrane  like  a mesentery.  It  is  a 
bag  ol  a pyriform  shape  ; its  greater  end  or  fundus  is  contigu- 
ous to  the  colon  ; its  lower  end  or  neck  to  the  duodenum.  It 
has  been  found  wanting  altogether.*  It  is  generally  of  a size 
to  contain  an  ounce,  or  an  ounce  and  a half  of  bile. 

The  coats  of  the  gall-bladder  are  the  outer  peritoneal  coat  ;f 
a middle  cellular  coat,  what  from  its  analogy  to  that  of  the  in- 
testines we  should  call  vascular  coat  ; and  an  inner  coat.  In 
the  intermediate  coat  muscular  fibres  have  been  looked  for  with 
great  eagerness,  but  none  have  been  demonstrated,  although  a 
conviction  remains  that  there  are  muscular  fibres  in  the  com- 
position of  the  coats  of  the  gall-bladder.  This  coat  gives 
form,  limit,  and  strength  to  the  gall-bladder.  The  third  or 
inner  coat  is  formed  into  innumerable  rugse,  so  as  to  take  a 
cellular  or  reticulated  texture.  These  loculi,  as  we  may  call 
them,  thus  formed  by  the  duplicature  of  the  internal  mem- 
brane, are  of  considerable  variety  of  shape,  square,  round, 
or  triangular.  These  rugae,  and  the  whole  internal  membrane 
of  the  gall-bladder,  have  a beautiful  and- minute  net-work  of 
vessels  upon  them  ; and  in  these  cells  there  can  be  little  doubt 
that  there  are  small  mucous  foilicules,  or  pores,  or  an  exudation 
from  extreme  vessels,  whose  discharge  sheaths  the  surface 
from  the  irritation  of  the  acrid  bile.  The  extreme  degree  of 
vascularity  and  reticulated  texture  of  this  inner  coat  of  the 
gall-bladder  is  not  apparent  before  the  sixth  or  seventh  month 
of  the  foetus,  and  then  it  takes  a peculiar  texture  in  preparation 
for  the  reception  of  the  secreted  bile. 

Towards  the  opening  of  the  bladder  into  the  cystic  duct  the 
rugse  take  a semilunar  figure,  and  seem  to  have  a valvular 
action,  in  at  least  so  far  that  they  seem  intended  to  give  a de- 
gree of  difficulty  to  the  passage  of  the  bile.  The  same  struc- 
ture of  the  internal  coat  prevails  in  the  cystic  duct. 

However  strange  it  may  appear  to  one,  considering  the  re- 
lation of  the  liver  as  a gland  to  its  ducts,  and  to  the  gall-bladder 
as  a receptacle  of  the  bile,  an  opinion  was  entertained  that  the 
bile  of  the  gall-bladder  was  secreted  by  its  own  coats,  and 
that  it  was  of  a different  nature  from  the  bile  conveyed  from 
the  substance  of  the  liver.  Without  further  argument  it  is 

• In  which  cafe  the  dilated  dufts  in  their  courfe  would  feeni  to  have  been  capable 
ef  retaining  a quantity  of  bile  ready  to  be  evacuated  into  the  inteftine.  A double 
gall-bladder  has  fometimes  been  found. 

t Like  the  peritoneal  coat  of  the  liver,  it  feems  to  pofftfs  very  diftintft  veflels 
from  the  vafcular  coat  below.  “ Si  itaque  ea,  a reliquis  membranis  folvitur  ex- 
pletis  antea  materia  quadam  colorata  vafis,  ab  arteria  hepatica  et  vena  portarum 
venientibus  ; videmus  cam  ne  minimum  quidem  accipere  furculum  quo  ornantlR’ 
Ttervea  et  •vafculofa."  Annotations  Acad.  F.  Aug.  Walter,  p.  57, 


OF  THE  LIVER. 


69 


sufficient  to  say,  that  when  the  cystic  duct  is  tied,  or  when  it  is 
preternaturally  obstructed,  there  is  no  bile  secreted  into  the 
gall-bladder.* 

From  the  connections  of  the  gall-bladder,  and  from  the 
consideration  of ' the  whole  anatomy,  there  can  remain  no 
doubt  that  the  gall-bladder  is  a mere  receptacle,  reserving  a 
sufficient  store  of  this  fluid  for  the  due  change  to  be  performed 
upon  the  food  : that  as  the  stomach  is  not  at  all  times  loaded 
with  food,  nor  the  chyme  and  fluid  from  the  stomach  inces- 
santly passing  through  the  duodenum,  neither  is  the  bile  at  all 
times  running  from  the  gall  ducts.  On  the  contrary,  as  the 
stomach  is  emptied  of  its  contents  at  stated  intervals,  there 
seems  to  be  a provision  for  a quantity  of  bile  being' evacuated 
from  the  receptacle  and  ducts  proportioned  to  the  food,  and 
while  it  is  passing  the  duodenum.  Whether  we  should  con- 
ceive that  this  is  a necessary  consequence  of  the  retention  of 
the  bile  in  the  gall-bladder,  or  a wise  provision  of  nature,  I am 
uncertain  ; but  it  appears,  that  the  longer  the  bile  is  retained, 
or  the  longer  the  fast  and  the  deficiency  of  food  in  the  duode- 
num,  the  more  acrid  and  inspissated  is  the  bile,  and  the  greater 
also  in  quantity.  This  inspissation  of  the  bile  takes  place  in 
consequence  of  the  activity  of  the  lymphatics,  which  ramifying 
on  the  coats  absorb  the  thinner  part  of  the  bile. 

Further ; I cannot  look  upon  the  rugae  and  cellular  structure 
of  the  inner  coat  of  the  gall-bladder  in  any  other  light  than  as 
the  means  of  increasing  the  surface,  and  exposing  the  bile  to  a 
further  absorption  of  its  watery  parts  than  otherwise  would 
take  place. 

The  gall  bladder  is  supposed  by  some  to  be  emptied  by  the 
general  pressure  of  the  abdomen  ; an  opinion  founded  on  ^ 
mistake,  which  a very  little  consideration  might  correct. 
Others  think  that  the  stomach,  or  duodenum,  or  colon,  being 
distended  by  the  food,  compress  and  empty  the  gall-bladder  ; 
while  others  with  more  apparent  correctness  allege,  that  it  is 
emptied  in  consequence  of  a consent  of  parts.  With  the  latter 
I would  confidently  affirm,  that  as  the  aliment  passes  the 
duodenum,  the  bile  follows  apace,  either  from  the  alternate 
contraction  and  relaxation  of  the  duodenum  occasioning  a re- 
laxation of  the  orifice  of  the  ducts,  or  more  probably  from  the 
ducts  being  excited,  as  the  salivary  glands  are  excited  by  the 
presence  of  sapid  bodies  in  the  mouth.  By  want  and  hunger, 

* Were  there  no  other  proof  of  the  gall-bladder  being  merely  a receptacle,  and 
not  in  any  degree  for  ferreting  the  bile,  the  courfe  of  its  veins  (which  run  into  the 
vena  porta;)  would  be  fufficient  indication  If  they  had  returned  the  blood  front 
having  performed  the  fecretion  of  the  bile,  they  would  have  dropt  into  the  cava, 
and  not  into  the  ports. 


70 


OF  THE  LIVER. 


on  the  contrary,  the  gall-bladder  is  allowed  to  distend  ; there 
is  no  call  for  its  evacuation. 

Experiments  would  even  teach  us,  that  the  gall-bladder  has 
not  the  same  irritability  excitable  by  stimuli  applied  to  the 
coats,  as  the  stomach,  intestines,  or  Sladder'of  urine  ; which 
is  a proof  that,  like  the  iris,  and  many  other  parts  of  the 
body,  its  action  is  roused  more  powerfully  by  the  stimulus  of 
sympathy  and  consent  of  remote  parts,  than  by  the  distention 
of  its  coats  ; whereas  the  intestines  and  bladder  have  it  in  their 
constitution  to  be  excited  to  contraction  by  simple  distention. 

From  experiments  it  would  appear,  in  confirmation  of  what 
is  here  alleged,  that  while  the  food  is  in  the  stomach  little  bile 
is  discharged  ; but  that  it  flows  when  the  matter  is  passing  the 
duodenum,  so  that  a great  quantity  is  then  formed  in  the  gut. 
On  the  contrary,  in  a state  of  want  and  hunger,  the  gall- 
bladder is  greatly  distended,  and  yet  little  bile  flows  from  it  ; 
although  it  is  not  only  more  accumulated,  but  more  acrid  and 
bitter.* 

The  gall-bladder  is  not  destitute,  however,  of  irritability 
and  the  power  of  contraction  ; for  it  would  appear  from  many 
cases  that,  like  the  urinary  bladder,  it  contracts  upon  concre- 
tions, and  becomes  thick  in  its  coats. 

The  retention  of  the  bile,  surcharging  the  ducts,  and  dis- 
tending the  gall-bladder,  and  the  sudden  discharge  of  ac- 
cumulated bile,  and  the  irregularities  of  its  course  when  in- 
fluenced by  disorder  of  the  viscera,  are  the  source  of  the 
most  severe  and  distressing  symptoms. f 

In  the  dead  body  we  see  the  colon  and  duodenum,  or  what- 
ever parts  lie  in  contact  with  the  gall-bladder,  stained  with 
bile  ; but  this  evidence  of  transudation  which  is  found  in  the 
dead  body,  is  not  seen  in  the  living  ; while  the  stain  from  the 
bile  is  observed  to  be  deeper  and  more  extensive  in  bodies  long- 
dead.  It  is  therefore  another  example  of  the  peculiar  proper- 
ties inherent  in  the  living  fibres,  that  no  transudation  is  allow 
ed  ; but  that  the  fluids,  which  appear  as  if  exuding  from  the 
living  surfaces,  are  discharges  from  organic  pores,  or  from  the 
extremities  of  vessels. 

OF  THE  MINUTE  STRUCTURE  OF  THE  LIVER. 

The  liver  is  firmer  and  dryer  in  some  degree  than  any  of 
the  other  viscera  ; the  intexture  of  membrane  is  weak,  and  in 

* Anat.  generale  de  Xav.  Bichattom.  iv.  p.  6 5. 

t We  have  one  example  of  this  in  a late  Treatife  on  the  Difeafes  of  the  Bowels 
of  Children,  by  Dr.  Cheyne  : an  elfay  mofl  particularly  ufeful  in  its  objects ; and 
the  reafoning  of  which  is  founded  on  anatomical  ohfcrvation,  fupported  by  fads 
and  dedudtions  from  pradice. 


OF  THE  LIVER. 


71 


consequence  the  substance  of  the  liver  is  friable  and  easily 
torn.  When  cut  or  torn,  it  seems  for  the  greater  part  vascu- 
lar ; or  it  displays  the  mouths  of  innumerable  ducts  and  ves- 
sels, and,  after  a minute  injection,  the  blood-vessels  seem  to 
pervade  every  particle,  even  when  examined  with  the  micros- 
cope. 

This  texture  of  vessels,  in  which  we  may  say  the  substance 
of  the  liver  chiefly  consistSj  is  surrounded  with  a delicate 
membrane,  the  continued  peritoneum.  It  retains  the  character 
of  peritoneum,  in  being  a simple  membrane,  whitish,  and  a 
little  pellucid.  In  this  membrane  minute  arteries  and  veins 
ramify,  which  are  unconnected  with  the  internal  system  oi 
vessels,  and  in  the  close  cellular  membrane  beneath  it  the 
lymphatic  vessels  take  their  course. 

When  a section  is  made  of  the  liver,  the  vessels  may  be 
thus  distinguished  : the  ducts  by  the  thickness  of  their  coats, 
and  their  yellow  colour ; the  arteries  by  a less  degree  of  thick- 
ness, and  a more  resisting  elasticity  ; the  branches  of  the  vena 
portae  and  the  cava  hepaticae  by  the  thinness  of  their  coats,  of 
which  those  of  the  latter  are  considerably  the  weaker. 

With  the  investiture  of  the  peritoneal  coat  of  the  liver  even 
the  vascular  tissue  of  the  body  of  the  liver  has  no  communica- 
tion by  vessels.*  It  is  therefore  considered  as  an  organ  of  a 
peculiarly  distinct  organization.  By  the  proofs  from  anatomi- 
cal injections  we  are  informed,  that  there  is  a free  intercourse 
through  the  extreme  branches  of  all  the  five  systems  of  vessels 
in  the  liver.  From  minute  injections,  and  the  trying  and 
making  of  sections  in  the  liver,  there  seems  no  likelihood  of 
gaining  information  of  the  structure  and  connections  of  these 
vessels.  Walther,  who  seems  to  have  examined  more  metho- 
dically and  minutely  than  any  other  anatomist  in  any  age, 
could  make  no  distinction  of  parts.  In  whatever  wav  he 
made  his  sections,  whatever  system  of  vessels  he  filled,  whe- 
ther the  whole  vessels  or  each  separately,  he  could  not  ascer- 
tain the  direction  and  course  of  any  particular  vessel,  nor  its 
inosculations,  but  all  was  obscure,  and  as  if  constituting  one 
chaotic  mass.  In  wet  preparations,  however,  he  observed, 
that  the  extremities  of  the  branches  of  the  hepatic  artery 
opened  into  the  vena  portae  : that  the  branches  of  the  vena 
portae  had  a double  termination  : that  some  of  them,  by  a sud- 
den turn  and  serpentine  course,  terminated  in  the  branches  of 
the  venae  cavae  hepaticaef  ; while  others  were  seen  to  terminate 

* Soemmering.  Walther,  loc.  cit.  &c. 

t * ftould  imagine  that  in  this  he  might  have  been  deceived  by  the  Idler 
branches  of  the  portae  (filled  with  injedHon)  opening  into  the  fide  of  the  larger 


72 


OF  THE  LIVER. 


or  open  into  the  biliary  ducts.  Further  he  observed,  that  in 
all  the  branches  of  the  vena  portae  there  was  a peculiar  com- 
pressed appearance  which  distinguished  them  from  all  the 
other  vessels  of  the  viscus. 

There  have  been  observed,  by  almost  every  author,  inter- 
sections of  the  intimate  membrane  of  the  liver,  which  divides 
and  subdivides  the  fasciculi  of  vessels.  These  are,  however, 
obscure  divisions.  The  last  perceptible  divisions  have  been, 
called  acini  ;*  and  they  are  rather  presumed  than  directly 
proved  to  have  in  their  composition  an  extreme  ramification  of 
the  several  vessels  of  which  the  liver  consists.f 

We  have  seen  Malpighi  conceiving  that  these  bodies  were 
simple  glands  collected  on  the  ramifications  of  the  vessels  ; 
that  they  were  little  vesicles  ; and  that  from  them  the  pori 
bilarii  took  their  origin.  In  this  opinion  he  was  successfully 
opposed  by  Ruysch,  who  affirmed  that  these  were  vascular ; 
and  in  this  he  has  been  supported  by  Albinus.  It  would  in 
truth  appear,  that  the  description  of  these  partitions  of  the 
substance  of  the  liver,  and  the  ultimate  subdivision  of  it  into 
these  little  grains,  about  which  there  has  been  so  much  specu- 
lation, is  not  founded  in  an  accurate  observation,  and  that  there 
are  neither  criptce,  hollow  or  cellular,  nor  little  bodies  made 
up  of  convoluted  arteries,  but  the  minute  parcels  of  vessels 
which  are  observable  may  be  called  acini,  in  the  strict  definition 
which  has  been  given  in  the  introduction. 

Finally,  Ruysch’s  opinion  may  be  given  in  these  words  : 
(Epist.  ad  Virum  Clar.  Ner.  Boerhaave,  p.  69.)  “ Sed  nolo 

diutius  tergiversari,  fateor  ergo,  quod,  quando  primo  incipie- 
bam  me  exercere  in  anatomicis,  videbam  tunc  quidem,  quod 
in  jecore  humano  se  ostendebant  acinuli  parvi  innumerabili 
numero,  qua:  turn  temporis  appellabantur  glandulae  ; nam 
nemo  cogitabat  aliter  sed  manet  sola  jam  hsec  questio,  an  aci- 
nuli  hi  hie  herentes  sint  glandulae  simplicissimae,  folliculi  cavi 
cum  emissario  an  quid  aliquid  ? dico  nemo  demonstravit  illos 
tales  esse  ut  hie  assumis.  Imo  vero  facile  jam  erit  demon- 
strate, acinos  hos  cum  criptis  antea  pertractis  nihil  commune 
habere  : quia  oculis  nostris  non  apparent  ut  membranulae  cavae 
& quia  etiam  non  habent  emissarium.  Sed  componuntur  tan- 
tum  ex  extremitatibus  ultimis  vasculorum  sanguiferorum  unitis 
in  formam  spherae  rotunditatis,  neque,  quantum  possum  videre 
etiam  membranula  aliqua  sua  singulari  circumambiuntur.” 

trunks ; and  that  there  is  no  fuch  termination  of  the  hepatic  arteries  in  the  fides  of 
the  vena  portarum,  fo  that  their  open  mouths  are  difcermhle. 

* See  the  definition  in  the  introduction  to  the  prefent  volume. 

t Acinos  nemo  reiicit,  ne  Ruyfchius  quidem,  fed  de  interiori  fabrica  difputatur- 
Haller. 


OF  THE  LIVER, 


OF  THE  SECRETION  OF  THE  BILE. 

Upon  reviewing  the  whole  system  of  the  liver  the  peculiari- 
ties in  the  vena  portae  strike  us  the  most.  It  occurs  to  us  that 
the  passing  of  this  profusion  of  blood  retrograde  into  the 
liver,  with  the  slow  motion  peculiar  to  venous  blood,  and 
after  having  gone  the  circulation  through  the  intestines,  and 
consequently  lost  those  properties  which  constituted  it  arterial 
blood,  is  a provision  for  the  secretion  of  the  bile.  It  is  almost 
universally  concluded,  that  the  secretion  of  bile  is  made  from, 
the  blood  of  the  vena  portae. 

But  as  we  see  that  this  blood  distributed  by  the  branches  of 
the  vena  portae  in  the  liver  must  be  so  far  exhausted  as  to  be- 
come incapable  of  all  the  uses  accomplished  by  the  arterial 
blood  in  other  glands,  that  although  the  vena  portae  be  pecu- 
liarly adapted  to  secrete  the  bile,  it  is  not  capable  of  supplying 
the  nutrition  and  the  energy  to  the  substance  and  vessels  of  the 
liver,  there  is  a necessity  for  arterial  blood  being  sent  to  this 
gland  through  a branch  of  the  arterial  s\  stem.  We  have  had 
occasion  to  remark,  that  no  part  retains  its  function  in  vigour, 
nor  the  living  properties  which  are  inherent  in  it,  while  the 
whole  osconomy  is  entire  and  correct,  unless  the  blood  be  cir- 
culated through  it.  Therefore  it  would  appear  necessarv  that 
the  arteria  hepatica,  a branch  of  the  aortic  system,  should 
also  be  bestowed  upon  this  viscus.  These  arteries  perform 
the  same  office  here  in  the  liver  that  the  bronchial  arteries  do 
in  the  lungs,  or  the  coronary  arteries  in  the  heart,  or  the  vasa 
vasorum  in  the  great  vessels.  The  pulmonic  artery  carries 
venous  blood  into  the  lungs,  which  having  returned  from  the 
circulation  of  the  body  cannoi  send  off  smaller  branches  to 
supply  the  membranes  and  vessels  of  the  lungs,  it  is  necessary 
that  for  this  purpose  branches  of  the  aortic  system  shall  enter 
the  lungs.  Again,  in  the  heart  the  blood  contained  in  its  ven- 
tricles is  incapable  of  supplying  its  substance,  or  the  blood 
coming  through  the  calibre  of  the  great  vessels  cannot  be  the 
means  of  ministering  to  their  active  powers,  but  for  this  pur- 
pose the  vasa  vasorum  are  distributed  through  the  coats  of  the 
vessels.  These  vessels  therefore  bear  an  analogy  to  the  arteria 
hepatica  in  the  liver. 

We  mu'st  not  however  suppose  that  this  scheme  of  the 
action  of  the  vascular  system  of  the  liver,  however  rational 
and  simple,  will  be  universally  allowed.  Indeed  there  are 
circumstances  which  seem  to  stand  in  opposition  to  it.  Of 
these,  the  most  interesting  is  the  case  of  unusual  distribution 
Vol.  IV.  K 


74 


01'  THE  L1V£R. 


of  the  vessels  of  the  liver  communicated  by  Mr.  Abernethy  of 
St.  Bartholomew’s  hospital. 

The  subject  was  a female  infant  which  was  supposed  to  be 
about  ten  months  old.  Among  other  varieties  it  was  observ- 
ed, that  the  branch  of  the  cceliac  artery  distributed  to  the  liver 
was  larger  than  common,  and  exceeded  by  more  than  one 
third  the  usual  size  of  the  splenic  artery.  This  was  the  only 
vessel  which  supplied  the  liver  with  blood  for  the  purpose  of 
either  nutrition  or  secretion.  The  vena  portarum  was  formed 
in  the  usual  manner,  but  terminated  in  the  inferior  cava  nearly 
on  a line  with  the  renal  veins.  The  liver  was  of  the  usual 
size,  but  had  not  the  usual  inclination  to  the  right  side  of  the 
body  : it  was  situated  in  the  middle  of  the  upper  part  of  the 
abdomen,  and  nearly  an  equal  portion  of  the  gland  extended 
into  either  hypochondrium.  The  gall-bladder  lay  collapsed  in 
its  usual  situation.  It  was  of  a natural  structure,  but  rather 
smaller  than  common.  On  opening  it  there  was  found  in  it 
about  half  a tea  spoonful  of  bile.  The  bile  in  colour  resem- 
bled that  of  children,  being  of  a deep  yellow  brown,  and 
tasted  like  bile,  but  it  was  not  so  acridly  bitter  and  nauseating 
as  common  bile. 

Mr.  Abernethy  remarks  upon  this  case,  that  when  an  anato- 
mist contemplates  the  performance  of  biliary  secretion  by  a 
vein,  a circumstance  so  contrary  to  the  general  ceconomy  ol 
the  body,  he  naturally  concludes  that  bile  cannot  be  prepared 
unless  from  venal  blood  ; and  he  also  infers,  that  the  equal  and 
undisturbed  current  of  blood  in  the  veins  is  favourable  to  the 
secretion  ; but  that  the  circumstances  of  this  case  in  which  bile 
was  secreted  by  an  artery  prove  the  fallacy  of  this  reasoning.* 

We  may  further  observe  on  this  case,  that  it  does  not  prove 
the  bile  in  the  natural  cecononty  to  be  secreted  by  the  arteries 
and  not  by  the  vena  portae  ; for  the  artery  here  was  unusually 
large,  so  that  it  performed  a function  in  this  instance  which  it 
does  not  usually  perform.  On  the  contrary,  had  the  artery 
been  of  the  usual  size,  we  might  then  have  concluded  that  the 
vena  portae  was  distributed  to  the  liver  to  serve  some  lesser  use 
in  the  ceconomy  of  the  system,  and  that  it  did  not  secrete  the 
bile. 

The  liver,  it  is  said,  was  of  the  ordinary  size.  Now  as  the 
bulk  of  the  liver  is,  in  its  natural  state,  made  up  of  the  dilated 
veins,  it  is  some  proof  of  what  I should  imagine  had  taken 
place  here,  that  by  some  provision  of  the  vessels  the  arterial 
blood  had  been  diffused,  and  the  celerity  of  its  motion  checked 

* See  Mr.  Abernethy’s  cafe,  of  uncommon  formation  of  the  liver.  Phys 
TranfaCtionb. 


OF  THE  LIVER. 


75 

previous  to  its  ultimate  distribution.  Nay,  it  may  have 
opened  into  the  branches  of  veins  answering  to  the  extremities 
of  the  vena  porta;. 

In  the  deficiency  of  the  due  acrid  and  bitter  state  of  the 
bile,  there  is  in  this  case  evidence  that  the  bile  formed  from  the 
arterial  blood  is  still  unfit  for  the  perfect  secretion.  I conceive 
this  to  be  countenanced  by  the  circulation  of  the  blood  in  the 
liver  of  the  foetus,  and  by  its  effects  upon  the  secretion.  We 
have  seen  that  almost  the  entire  gland  is  supplied  with  arterial 
blood  returning  from  the  umbilical  vein  ; and  the  natural 
deduction  from  this  is,  that  it  is  the  cause  of  the  less  stimulat- 
ing quality  of  the  bile  in  the  foetus. 

I conclude,  that  this  singular  and  interesting  case  may 
strengthen  the  opinion  which  some  have  entertained  that  the 
extreme  branches  of  the  hepatic  artery  pour  blood  into  the  ex- 
tremities of  the  vena  port*  previous  to  this  formation  of  the 
bile  by  these  veins  ; but  it  strll  leaves  us  with  the  general  con- 
clusion that  the  peculiarities  in  the  distribution  of  the  vena 
portae  are  a provision  for  the  secretion  of  the  bile,  and  that  the 
branch  of  the  aortic  system,  the  hepatic  artery,  is  otherwise 
necessary  to  the  support  of  the  function  of  the  liver. 

Finally,  as  to  the  use  of  the  liver  independently  of  the 
secretion  of  the  bile,  we  must  lay  aside  the  opinions  mentioned 
by  Haller  that  it  supports  the  diaphragm,  protrudes  it  up  in 
expiration,  and  receives  the  contraction  of  it  equally  in  inspira- 
tion, so  as  uniformly  to  compress  the  other  abdominal  viscera  ; 
or  that  it  foments  and  cherishes  the  stomach  by  the  heat  of  its 
blood.  These  are  at  least  as  bad  as  the  theories  of  the  ancients 
mentioned  in  the  beginning  of  this  section.  Haller’s  failing  is 
the  promiscuous  admittance  of  all  facts  and  every  kind  of 
theory,  with  a timorousness  and  indecision  in  giving  his  own 
opinion. 

There  is  another  remark  of  Haller  which  deserves  attention. 
When  I reflect,  says  he,  that  there  is  no  bile  required  in  the 
foetus,  there  being  no  food  received  : when  again  I see  that  the 
liver  is  of  great  size  in  the  foetus,  and  not  small  like  the  lungs, 
which  are  destined  to  an  operation  in  the  ceconomy  after  birth, 

I cannot  but  suspect  that  it  has  some  other  use  in  the  foetus  than 
the  secretion  of  the  bile.  If  the  umbilical  vein  had  opened 
directly  into  the  cava,  he  thinks  it  would  have  returned  with 
too  great  an  impetus  upon  the  heart,  and  would  by  its  prepon- 
derancy  have  retarded  the  return  of  the  blood  from  the  lower 
extremities.  He  thinks  that  the  liver  is  useful  in  breaking  and 
weakening  the  impulse  of  the  blood  from  the  umbilical  vein  ; 
that  it  is  a guard  to  the  right  auricle,  which  would  be  other- 
tv;  ;s  endangered  by  the  rapid  flow  of  the  blood.  Now  surely 


OF  THE  PANCREAS. 


the  liver  is  much  less  able  tc  stand  the  impulse  of  the  blood 
than  the  heart ; and  yet  there  is  no  provision  for  the  breaking 
of  the  force  of  the  blood  in  the  liver.  FurthSr,  there  is  a 
direct  duct  of  communication  leading  to  the  heart.  There  is 
r.o  reason  to  believe  that  the  umbilical  vein  carries  back  the 
blood  witli  greater  force  than  any  other  returning  vein  : on  the 
contrary,  from  its  size  and  the  length  of  its  course  it  is  natural 
to  suppose  the  motion  of  the  blood  in  it  to  be  very  slow  and 
equable. 

We  must  look  upon  the  peculiarities  in  the  circulation  of  the 
blood  in  the  liver  of  the  foetus  as  a provision  against  the  secre- 
tion of  stimulating  bile  ; for  when  the  child  is  born  and  the 
circulation  altered,  bile  is  formed  more  abundantly,  and  be- 
comes the  stimulus  to  the  whole  abdominal  viscera,  rousing 
them  to  new  action.  As  to  the  comparison  which  Haller  has 
made  between  the  state  of  the  liver  and  that  of  the  lungs,  it  is 
evident  that  the  latter,  though  small  in  bulk,  are  fully  formed, 
and  want  only  inflation  to  complete  their  function.  On  the 
contrary,  in  the  liver  of  the  foetus  the  vessels  are  necessarily 
distended  with  blood,  to  give  them  the  size  requisite  for  this 
future  function  ; but  that  blood,  either  from  its  qualities  or 
from  the  easy  and  direct  passage  it  has  into  the  heart,  does  not 
secrete  the  bile  in  quantity  and  quality  so  as  to  stimulate  the 
ducts  and  intestines,  as  in  the  adult  circulation.  If  it  did,  we 
should  not  see  the  alimentary  canal  of  the  feetus  loaded  with 
matter,  and  yet  not  stimulated  to  action,  but  in  a state  of  in 
'activity  and  torpor. 


SECTION  II. 


OF  THE  PANCREAS. 

The  Pancreas  is  a gland  the  largest  of  those  which  have 
be  n called  conglomerated,  that  is,  distinctly  consisting  of 
lesser  parts  united.  It  is  of  a long  form  like  a dog’s  tongue, 
and  lies  across  the  spine,  and  behind  the  stomach.  Its  excre- 
tory duct  opens  into  the  duodenum. 

The  pancreas  is  confined  betwixt  the  two  lamina  of  the  me- 
socolon, and  it  is  united  to  them  by  a loose  cellular  membrane  ; 
it  lies  before  the  great  mesenteric  vessels  : its  small  extremity 
touches  the  spleen,  and  is  near  the  capsuli  of  the  left  kidney-: 
but  towards  the  right  extremity  it  increases  gradually  in  jna#sit 


OF  THE  PANCREAS. 


w 

ness  until  its  head  lodges  upon  the  duodenum.  It  is  like  the 
salivary  glands  in  its  appearance,  consisting  of  lobules  succes- 
sively smaller  and  smaller  ; and  it  also  resembles  them  in  the 
manner  in  which  its  duct  is  formed.  The  duct*  begins  to- 
wards the  left  extremity  by  exceedingly  small  branches  ; these 
running  together  form  a middle  duct,  which  taking  a serpen- 
tine course  towards  the  great  extremity,  and  increased  by  the 
accession  of  the  lateral  branches  in  its  course,  becomes  nearly 
of  the  size  of  a writing  quill.  Now  approaching  the  duode- 
num it  unites  to  the  biliar^  duct,  and  opens  along  with  it  into 
the  duodenum.  A valve  has  been  described  as  in  the  ex- 
tremity of  the  pancreatic  duct,  but  it  is  certainly  incapable  of 
the  action  of  a valve,  as  the  bile  has  been  found  to  have  gone 
retrograde  into  the  trunk  of  the  pancreatic  duct.  Sometimes 
there  are  two  pancreatic  ducts,  but  more  frequently  the  part  of 
the  gland  next  the  duodenum,  and  which  is  called  the  round 
head  of  the  pancreas, f has  an  excretory  duct  peculiar  to  itself, 
which  either  opens  into  the  duodenum  separately  from  the 
main  duct,  by  piercing  the  coats  of  the  intestines  nearer  the 
stomach,  or  sometimes  opens  further  do>vn. 

De  Graff,  Ruysch  and  many  others  have  made  experiments 
to  discover  the  nature  of  the  secretion  from  the  pancreas. 
Tubes  were  introduced  into  the  ducts,  and  bottles  were  ap- 
pended to  them  in  living  dogs,  so  as  to  catch  the  pancreatic 
fluid  : it  was  found  ropy,  insipid,  and  like  the  saliva.  It  has 
therefore  been  concluded,  from  the  colour,  structure,  ducts, 
and  secretion  of  the  pancreas  having  so  strict  a resemblance  to 
those  of  the  parotid  and  submaxillary  glands,  that  it  is  of  the 
nature  of  the  salivary  glands  of  the  mouth.  The  general 
opinion  has  been,  that  it  is  useful  in  secreting  a fluid  which 
dilutes  and  moderates  the  acrimony  of  the  bile.  More  accu- 
rate chemical  examination  of  the  pancreatic  fluid  has  not  been 
made,  or  has  not  been  successful  in  showing  any  peculiarity 
in  it. 

Considering  the  pancreas  as  a salivary  gland,  hotv  great 
must  be  the  quantity  of  fluid  poured  out  by  it,  if,  as  we  are 
entitled  to  do,  we  take  the  analogy  of  the  parotid  submaxillary 
and  sublingual  glands.  These  salivary  glands,  although  they 
may  be  said  to  surround  all  the  jaws  from  the  zigomatic  pro- 
cess on  either  side,  are  nothing  in  massiness  and  size  to  the 
pancreas.  Again,  the  pancreas  is  most  plentifully  supplied 
with  blood-vessels.  Besides  lesser  branches  of  arteries,  the 
pancreatico-duodenalis  gives  two  branches,  which  take  an  ex- 

" Du&us  Virfungi. 

f This  is  what  Winllow  calls  the  little  pancreas,  and  is  fometimes  schirrous  fo 
as  to  comprefs  the  biliary  dinfts. 


ra 


OF  THE  PANCREAS. 


tensive  course  through  it,  and  are  joined  by  other  mesenteric 
twigs  ; and  twigs  proceed  from  the  vessels  of  the  stomach,  and 
even  irom  the  hepatic  artery  ; but  more  particularly  we  have 
to  observe  the  large  branches  bestowed  upon  it  by  the  splenic 
artery,  where  it  takes  its  course  close  upon  it. 

While  the  masticators  are  working,  the  parotid  gland  pours 
out  so  great  a quantity  of  saliva,  says  M.  Helvetius,  that  it  is 
inconceivable,  and  what  I should  not  believe,  had  I not  seen  it 
in  a soldier  of  the  guards.  A cut  with  a sabre  in  the  cheek 
had  opened  the  salivary  duct : the  wtmnd  healing  on  the  inside 
of  the  cheek  left  a fistulous  discharge  from  the  parotid  duct. 
When  he  eat,  there  flowed  from  this  hole  a great  abundance  of 
saliva,  so  that  during  dinner,  which  is  not  long  in  the  Hotel 
Dieu,  it  moistened  several  napkins.  How  much  must  flow 
from  all  the  salivary  glands  ? How  much  from  the  pancreas, 
which  is  greater  than  them  all  collectively  ? 

Like  the  biliary  secretion  it  is  probable  that  the  contents  of 
the  stomach  passing  the  duodenum  or  the  bile  flowing  from  the 
biliary  ducts,  form  the  stimulus  to  the  discharge  of  the  pancre- 
atic fluid  ; and  as  we  see  that  the  morsel  in  the  mouth  will 
quickly  produce  an  almost  instantaneous  secretion  and  dis- 
charge of  saliva,  so  we  are  led  to  ’conclude  that  the  flow  of 
pancreatic  fluid  may  be  as  suddenly  produced  without  the  ne- 
cessitv  of  a reservoir,  as  in  the  biliary  system.  We  naturally 
conceive  that  the  effect  of  this  fluid  is  to  diminish  the  viscidity 
of  the  bile,  and  by  diluting  it  to  mix  it  uniformly  with  the  food. 
There  are  however  few  facts  to  enable  us  to  reason  on  the  ef- 
fects of  the  pancreatic  fluid.  If  we  give  full  credit  to  the  ex- 
periments of  Malpighi  and  Brunner  we  may  conclude,  that 
when  the  pancreas  is  taken  away,  the  more  acrid  bile  causes 
vomiting  or  voracious  appetite  by  its  stimulus.  Schirrus  of 
the  pancreas  has  been  found  attended  with  a costive  and  slow 
motion  of  the  intestines  ; which  seems  to  contradict  the  result 
of  these  experiments  on  animals;  but  by  the  schirrosity  and 
enlargement  of  the  pancreas  the  biliary  ducts  may  have  been 
more  or  less  compressed,  and  the  retarding  of  the  usual  quan- 
tity oi  the  biliary  secretion  might  produce  the  slowness  of  the 
bowels.'* 

* According  to  the  hypothetic  of  Silvius,  the  ufe  of  the  pancreas  was  to  fupply 
an  acid  fpirit  or  juice,  and  the  biliary  fecretion  being  of  the  nature  of  an  alkali, 
thefe  two  llruggling  together  caufed  the  reparation  of  the  chyle  Irom  the  feces. 
This  good  fight  did  not  flop  here,  but  thefe  enemies  being  carried  into  the  blood, 
Continued  their  warfare  in  the  heart  itelfand  lighted  up  the  vital  flame  there. 

Nay,  if  we  believe  the  experiment  of  F.  Schuly,  (dc  Veteri  Med.J  this  hypothefis 
■was  not  without  its  proofs  ; for  having  tied  in  the  portion  of  the  duodenum  ol  a 
living  dog,  where  the  pancreatic  and  biliary  duds  enter,  he  law  the  ebulition  Irom 
this  ftruggle  of  the  acid  and  the  alkali ; and  when  he  comprefied  the  hepatic  dud:. 


OF  THE  SPLEEN. 


/ 


SECTION  III. 


OF  THE  SPLEEN. 

The  spleen  is  a viscus  of  an  irregular,  oval  figure,  and  dark 
purple  colour.  It  is  attached  to  the  great  extremity  of  the 
stomach.  It  is  soft  in  its  substance  ; and  has  the  peritoneal 
coat  very  delicate.  We  should  be  glad  could  we  say  that  it  is 
of  a parenchematous  structure,  for  in  truth  little  is  known  of 
its  organization. 

In  treating  of  this  subject  we  must  be  indulged  in  some  spe- 
culation ; and  indeed  it  is  priviledged  ground  ; for  the  history 
of  the  opinions  regarding  the  supposed  function  of  the  spleen 
is  full  of  loose  conjectures  or  wild  hypothesis,  and  nothing  is  as 
yet  certainly  known  of,  its  use. 

SEAT  AND  CONNECTIONS. 

The  spleen  is  seated  in  the  left  hypochondrium  ; above  the 
left  kidney  ; and  under  the  protection  of  the  false  ribs  ; and  of 
course  it  is  under  the  edge  of  the  diaphragm.  It  is  connected 
with  the  stomach  by  the  cellular  membrane,  by  the  omentum 
and  in  a still  more  particular  manner  by  the  vasa  brevia.  It 
has  also  connections  with  the  left  extremity  of  the  pancreas  by 
cellular  membrane,  and  the  branches  of  the  splenic  vessels. 
Lastly,  it  has  a firmer  attachment  to  the  diaphragm,  by  means 
of  a ligament  formed  by  the  peritoneum.* 

The  spleen  is  of  no  regular  figure.  Where  it  is  contiguous 
to  the  diaphragm  it  is  uniformly  convex  : towards  the  stomach 
its  surface,  while  it  is  hollowed  out  and  concave,  presents  two 
sides,  so  that  we  say  the  whole  mass  is  somewhat  of  a triangu- 
lar form.  The  anterior  edge  of  the  spleen  is  notched  with 
deep  sulci  ; behind  and  at  the  upper  part  the  margin  is  large 
and  round. 

The  substance  of  the  spleen  is  the  most  spongy,  tender,  and 
soft  of  the  abdominal  viscera  ; so  much  so  that  not  only  does 
the  finger  make  an  impression  upon  its  surface,  but  it  actually 
disorders  and  tears  its  vessels.  After  a successful  injection  the 

the  tumefaction  of  the  inteftine  fubfided ; when  he  took  off  this  comprefiion  it 
was  again  blown  up.  As  this  experiment  has  not  fucceeded  fince,  as  Haller  ob- 
ferves,  Schuyl  was  probably  deceived  by  the  periftaltic  motion  of  the  inteftines. 

* Yet  the  fpleen  is  very  apt  to  change  its  Ctuation,  or  to  fall  down  under  the 
protection  of  the  falfe  ribs.  It  is  liable'to  enlargement  in  afcites.  From  which 
circumftances  it  will  not  be  wonderful  if  it  i9  wounded  in  tapping  for  the  afcites. 
See  Monro  on' Dropfy. 


80 


OF  THE  SPLEEN. 


whole  seems  made  up  of  vessels  ; and  if  any  thing  like  acini 
or  globules  are  to  be  observed,  the  microscope  will  show  them 
to  be  accidentally  produced  by  the  fasciculi  of  vessels.  It  has 
a strict  resemblance  to  the  substance  of  the  placenta.  The 
spleen  is  seldom  smaller  than  natural ; often  greatly  enlarged. 
I have  seen  it  equal  to  the  liver  in  size,  and  filling  the  whole 
left  side  of  the  belly.  It  has  been  frequently  found  thus  en- 
larged, without  any  peculiar  symptoms  indicating  such  a dis- 
ease during  life.  From  its  soft  texture  and  great  vascularity, 
like  the  liver,  it  has  been  found  rent  by  blows  and  falls  ; and 
wounds  here,  as  in  the  liver,  by  opening  the  large  vessels  are 
suddenly  fatal.  Sometimes  it  is  hard  and  schirrous,  and 
marbled  in  its  colour.  There  is*  seldom  suppuration  in  it. 
The  spleen  has  been  supposed  to  swell  up  and  enlarge  when 
the  stomach  is  empty,  and  to  be  contracted  when  it  is  full.  It 
has  been  observed,  that  it  is  large  and  spongy  in  those  who 
have  died  a lingering  death,  or  who  have  been  long  ailing : 
that  on  the  contrary,  it  is  smaller  and  firm  in  those  who  have 
died  suddenly  of  a violent  death. 

We  are  informed,  that  the  blood  of  the  splenic  vein  is  pecu- 
liar, insomuch  that  it  does  not  coagulate  like  the  blood  in  the 
other  veins  of  the  body.'* 

That  which  more  than  any  other  circumstance  excites  our 
attention,  is  the  great  size  of  the  blood  vessels  of  the  spleen. 
Both  the  splenic  vein  and  the  artery  are  of  great  size  in  pro- 
portion to  the  bulk  and  weight  of  the  spleen  ; and  in  their 
course  they  are  particularly  tortuous.  I conceive  we  may  also 
draw  consequences’ from  the  distribution  of  their  brum  lies  to 
the  stomach  (viz.  the  vasa  brevia  and  left  g astro  epiploic)  and 
to  the  pancreas.  Its  lymphatics  are  numerous.  It  is  supplied 
with  nerves,  but  has  very  little  sensibility.  It  has  no  excretory 
duct. 

OPINIONS  REGARDING  THE  USE  OF  THE  SPLEEN. 

• 

Of  the  various  uses  of  the  spleen,  the  lowest  conjecture  in 
respect  to  ingenuity  or  probability  is,  that  like  a sand-bath  it 
foments  the  stomach,  and  promotes  the  process  of  digestion. 
This  notion  is  perhaps  not  inferior  in  absurdity  to  that  opinion 
which  ascribed  to  the  spleen  the  office  of  forming  an  acid  juice, 
which  being  carried  by  the  vasa  brevia  into  the  stomach,  was- 
supposed  to  excite  the  appetite.f 

* With  regard  to  this  point  I have  no  opinion,  having  hitherto  negledted  to 
examine  the  fadt. 

f 1 am  miftaken  in  calling  this  the  lowed:  in  abfurdity.  The  fpleen  has  been 
confidercd  as  the  feat  of  the  foul!  the  caufe  of  venereal  appetite!  the  gland 


OF  THE  SPLEEN. 


8X 


it  was  a better  conception  that  the  spleen  is  the  seat  of  me- 
lancholy ; “ that  moping  here  doth  hypochondria  sit  or  of 
“ laughter  holding  both  his  sides,”  of  which  the  holding  of  the 
sides  was  an  evidence.  And  again,  since  tickling  the  ribs  is  a 
demonstration  of  the  effect  from  this  excitement  of  the  spleen,*1 
that  the  growth  of  the  spleen  promotes  laughter  to  such  a de- 
gree, that  it  becomes  a permanent  silly  simper  impertinently 
excited.  Nay  further,  we  have  authority  for  the  excision  of 
the  spleen  from  those  who  are  otherwise  incurable  in  their  pro- 
pensity to  laughter. 

The  following  is  a theory  which  has  been  very  commonly 
received.  A great  quantity  of  blood  is  imported  into  the 
spleen  with  a slow  motion,  owing  to  its  serpentine  course. 
When  the  stomach  is  empty,  the  blood  is  received  in  a greater 
quantity  by  the  spleen,  where  it  has  an  opportunity  of  stagnat- 
ing. Here  the  blood  fomented,  attenuated,  and  in  a manner 
dissolved  by  the  neighbourhood  of  the  putrid  fseces  in  the  co- 
lon, enters  upon  the  first  steps  of  a begun  putrefaction.  By 
this  resolving  of  the  blood  it  is  made  more  fluid,  in  which 
state  it  is  returned  by  the  veins,  there  being  no  excretory 
ducts.  Now  when  the  spleen  is  compressed  between  the 
distended  stomach  and  the  ribs,  and  the  contracting  dia- 
phragm, the  blood  is  pressed  out  from  it  in  greater  quantity 
and  celerity  towards  the  liver,  mixing  with  the  sluggish  blood 
in  the  trunk  of  the  vena  portae,  replenished  with  the  fat  and  oil 
of  the  omentum,  it  dilates  it  and  prevents  its  stagnation  and 
tendency  to  congeal.  In  short,  the  spleen  has  been  supposed 
to  be  subservient  to  the  function  of  the  liver,  and  to  the  pre- 
paration of  a watery  (and  subalkaline)  fluid  to  the  blood  of  the 
portae.  Another  opinion  has  been,  that  it  counterbalanced  the. 
mass  of  the  liver  seated  to  the  right  side  of  the  belly. 

Hewson  entertained  a theory  regarding  the  use  of  the  spleen 
which  sullies  his  high  character  and  reputation.  He  conceived 
that  the  spleen  added  the  flat  vesicle  of  the  globules  of  the- 
blood  : his  only  observation  in  way  of  proof  was,  that  he  saw 
a few  red  globules  returning  by  the  lymphatics  of  the  spleen  : 
the  effect,  I have  no  doubt,  of  the  injury  of  its  ■substance,  or 
of  the  compression  of  its  vessels.  It  seems  to  me  strange  that. 

which  formed  the  mucilaginous  fluids  of  the  joints ! The  atrabilis  was  received 
here  concocted  and  tranfmitted  to  the  liver.  It  drew  forth  and  formed  blood  front 
the  ftomach,  &c.  Other  phyfiologifts,  not  contented  with  the  theories  prefented 
to  them,  and  yet  incapable  of  fuggefting  others  more  likely,  have  very  modeftly 
afferted  that  the  fpleen  was  of  no  ul'e  at  all. 

* Rifus  in  liene  fedes  videtur  ex  effedfu  titilationis  nataque  in  plurimis  mcrtali- 
hus  rifum  excitat.  &c.  Haller,  His  fober  objection  is,  that  tickling  the  right  fide 
will  do  as  well  as  the  left. 


82 


OF  THE  SPLEEN. 


such  a man  seeing  the  large  splenic  artery  throwing  its  full  tide 
of  perfect  arterial  blood  into  the  spleen,  full  of  globules,  com- 
plete in  every  respect,  and  again  seeing  a few  globules  carried 
back  by  the  lymphatics,  should  imagine  that  this  artery  formed 
these  few  vesicles  with  which  it  was  already  so  fully  charged. 

Oflate  years  we  have  seen  men  endeavouring  to  raise  them- 
selves into  notice  by  an  attachment  to  the  opinions  of  their 
departed  patrons  ; by  supporting  those  opinions  ; by  holding, 
as  they  imagine,  the  proofs  and  illustrations  of  them  in  their 
possession  : but  seldom  do  we  see  the  memory  of  great  men 
honoured  by  such  obsequies.  The  officiousness  of  Hewson’s 
friends  in  promulgating  his  opinions  has  done  no  honour  to  his 
memory.  They  have  attempted  to  support,  on  insufficient 
grounds,  what  he  might  have  had  the  ingenuity  to  render 
plausible,  and  which  are  very  far  from  honourable  to  his  repu- 
tation, imperfect  as  they  now  appear. 

I conceive  the  spleen  to  be  an  organ  subservient  to  the  sto- 
mach : and  not  only  the  constant  attachment  of  it  to  the  sto- 
mach in  the  human  body,  but  the  constancy  with  which  it  is 
found  connected  with  the  stomach  in  the  lower  animals,  con- 
firms the  opinion.  I regard  it  as  a provision  for  giving  the 
vessels  of  the  stomach  an  occasional  power  and  greater  acti 
vity,  enabling  them  to  pour  out  a quantity  of  fluid  proportioned 
to  the  necessity  of  the  digestion.  In  the  first  place,  let  us  ex- 
amine the  course  and  form  of  the  splenic  artery,  and  I think 
we  shall  find  the  great  peculiarity  of  its  size,  and  tortuous 
form,  and  strong  coats,  a provision  for  occasional  great  in- 
crease of  power  ; while,  if  not  roused  by  the  peculiar  sympa- 
thies which  actuate  it,  it  is  of  a form  to  retard  and  weaken  the 
velocity  of  the  blood.  This  is  founded  on  these  propositions  : 

1.  The  muscular  power  of  an  artery  increases  as  it  recedes 
from  the  heart ; the  elastic  power  diminishes. 

2.  An  artery,  the  nearer  it  approaches  to  its  final  distribu- 
tion, is  the  more  immediately  under  the  excitement  and  con- 
troul  of  the  organ  ; is  active  when  the  organ  is  excited  ; is, 
relatively  speaking,  quiescent  when  that  organ  is  not  called  by 
its  sympathies  to  exercise  its  function. 

3.  An  artery  tortuous  in  its  course  has  more  muscularity 
and  greater  power  of  action  than  one  which  takes  a straight 
course  ; but  in  proportion  to  the  increase  of  power  which  it 
obtains  by  its  increase  of  length  in  this  tortuous  and  bending 
course,  will  these  turns  retard  and  weaken  the  force  of  the 
heart  upon  the  extreme  ramifications  of  the  vessel. 

Thus  a tortuous  artery  is  the  means  of  increasing  the  velo- 
city of  the  blood  by  its  own  action,  but  it  makes  the  organ  less 
dependent  on  the  general  force  of  the  circulation.  We  ac™ 


OF  THE  SPLEEN. 


85 


cordiflgly  find  that  in  those  organs  where  there  is  occasional 
activity  alternating  with  a quiescent  state,  the  artery  is  tortu- 
ous ; and  where  there  is  an  increase  of  force  required  in  the 
circulation,  there,  the  artery,  from  being  straight  in  its  course, 
becomes  crooked  and  twisted  in  every  way.* 

From  these  remarks,  we  may  be  inclined  to  draw,  from  the 
tortuous  figure  of  the  splenic  artery,  a conclusion  somewhat 
different  from  that  which  has  hitherto  been  deduced.  We 
may  conclude  that  it  is  not  the  means  of  retarding  the  blood  in 
its  circulation,  but  of  giving  force  to  it.  The  splenic  artery 
does  not  only  ramify  in  the  spleen,  but  it  supplies  all  the  left 
part  of  the  stomach,  and  that  great  sacculated  extremity  in 
particular  which  receives  the  food,  and  in  which  the  process 
of  digestion  is  chiefly  performed.  My  idea  is,  that  when  the 
stomach  is  empty,  when  there  is  no  food  in  it  to  solicit  the  dis- 
charge of  the  gastric  fluid,  the  blood  circulates  in  a moderate 
degree  in  the  coats  of  the  stomach,  and  the  spleen  receives  the 
surcharge  of  blood  ; but  when  a full  meal  is  taken  into  the 
stomach,  when  the  action  of  the  gastric  juice  is  required  in 
great  quantity,  the  action  of  the  splenic  arteiy  is  solicited  to 
the  vasa  brevia  and  left  gastroepiploic  artery,  and  thus  a sud- 
den flow  of  the  gastric  fluid  is  bestowed  by  the  increased 
activity  of  the  splenic  artery.  When  again  the  contents  of  the 
stomach  are  fully  saturated  with  the  fluids  from  its  coats,  there 
is  no  longer  an  excited  action  of  the  splenic  vessels,  and  the 
artery  terminating  in  the  veins,  the  spleen  returns  the  blood  to 
the  liver.  While  the  vessels  of  the  stomach  partake  largely 
of  the  supply  of  blood,  the  arteries  to  the  pancreas  also  re- 
ceive some  increase  of  activity  ; and  even  the  blood  of  the 
vena  portae  requires  an  additional  activity. 

We  have  seen  that  the  stomach  and  intestines,  the  liver, 
pancreas,  and  spleen  are  combined  in  function,  connected  by 
the  same  system  of  vessels,  mutually  subservient  to  each 
other,  and  tending  to  the  same  end,  the  reception,  digestion, 
and  first  stage  of  the  assimilation  of  nutritious  matter  to  the 
system.  We  leave  this  subject  therefore  until  we  can  take  up 
that  of  absorption  and  the  lymphatic  system,  and  pass  to  the 
kidney  and  viscera  of  the  pelvis. 


* This  has  been  fuppofed  the  effect  of  the  impulfe  of  the  blood,  but  nothing  can 
be  more  falfe.  Let  any  one  examine  the  artery  of  a limb  when  a great  tumour  is 
growing ; the  artery  will  be  found  tortuous  to  fupply  it.  Again,  in  the  aneurifmal 
varix  where  there  is  a breach  in  the  artery,  and  the  blood  finds  a freer  return  to  the 
heart,  the  artery  will  be  found  enlarged  and  tortuous  in  order  to  fupply  the  lower 
part  of  the  limb  ; while  there  is  a quantity  of  the  blood  withdrawn  from  the  circu- 
lation by  the  communication  with  the  vein. 


OP  THE  JtlDHET. 


SECTION  IV. 

OF  THE  KIDNEY. 

The  kidnies  are  distinct  from  those  parts  which  have  hitherto 
engaged  us,  as  they  secrete  the  urine,  and  form  therefore  the 
link  betwixt  the  viscera  of  the  abdomen  and  those  of  the  pel- 
vis ; for  though  lying  in  the  abdomen,  they  are  more  strictly 
connected  with  the  parts  in  the  pelvis.  The  structure  of  the 
kidney  forms  a very  interesting  subject  of  inquiry  ; because  it 
is  the  field  of  dispute  betwixt  the  contending  parties  regarding 
the  structure  of  glands  and  the  theory  of  secretion.  It  is 
chiefly  from  the  kidnies  that  the  facts  are  drawn  in  illustration 
of  the  opinions  of  Malpighi,  Ruysch,  and  all  the  others. 

Form,  seat,  and  connections.  The  kidnies  lie  on  each 
side  of  the  spine  ; sunk  as  it  were  in  the  fat  of  the  loins ; 
attached  to  the  muscles  of  the  loins  ; and  in  part  lying  on  the 
lower  belly  of  the  diaphragm  ; which  last  connection  is  the 
cause  of  the  pain  felt  in  respiration  during  inflammation  in  the 
kidney.  The  kidney  lies  betwixt  the  spine  of  the  ilium  and 
the  lowest  rib.  The  right  kidney  is  placed  somewhat  lower 
than  the  left,  which  is  owing  to  the  great  size  of  the  liver  on 
that  side. 

The  kidnies  are  without  the  abdomen,  that  is  to  say,  behind 
the  peritoneum  ; for  the  kidney  lying  close  upon  the  muscles 
of  the  loins,  the  peritoneum  is  merely  stretched  over  it.  This 
is  the  reason  why  calculi  in  the  kidney  have  wrought  them- 
selves out  by  fistulse  in  the  loins  ; and  it  is  the  ground  of  the 
hazardous  proposal  of  cutting  into  the  kidney  to  extract 
calculi. 

The  adipose  membrane  surrounds  the  kidney,  and  forms  a, 
perfect  capsule  ; for  it  is  this  which  is  sometimes  in  an  extra- 
ordinary degree  loaded  with  accumulated  fat.  Upon  this  cap- 
sule the  caecum  is  attached  on  the  right  side,  the  colon  on  the 
left,  and  betwixt  the  kidnies  and  the  intestines  there  is  a strict 
Sympathy,  which  is  apparent  in  the  nephritic  colic. 

The  figure  of  the  kidney  is  that  of  an  oval  bent,  or  a little  in- 
curvated,  so  as  to  form  a sulcus  or  general  concavity  to  one 
side,  while  the  other  takes  a greater  convexity.  By  the  con- 
cave surface  of  the  kidney,  which  is  towards  the  spine  and 
great  vessels,  the  arteries  and  veins  and  ureter  pass  in  by  the 
sinus  round  which  the  substance  or  glandular  body  of  the  kid- 
ney terminates  abruptly. 

The  abdominal  aorta  and  the  vena  cava  lying  close  on  the 
spine  and  near  to  each  other,  give  off  laterally  the  emulgejjt 


OV  THE  KIDNEY. 


85 


arteries  and  veins.  The  renal  or  emulgent  artery  comes  from 
the  side  of  the  aorta  betwixt  the  upper  and  the  lower  mesenteric 
arteries  : that  of  the  left  kidney  has  its  origin  a little  higher 
than  the  right  : and  the  aorta  being  on  the  left  and  the  cava 
towards  the  right  side  of  the  spine,  the  left  emulgent  artery  is 
shorter  than  the  vein  ; the  artery  longer  than  the  vein  on  the 
right  side.  Again,  the  aorta  being  more  closely  attached  to 
the  spine,  the  emulgent  vein  lies  rather  above  the  artery. 

The  vessels,  and  especially  the  arteries  of  the  kidney,  are 
very  irregular  in  their  number  and  form.  Where  they  enter 
the  body  of  the  gland,  they  are  accompanied  with  a capsule 
which  continues  with  them  to  this  final  distribution.  Some- 
times a solitary  vessel  is  seen  making  its  exit  by  the  convex 
surface  of  the  kidney. 

We  have  had  occasion  to  remark  on  the  nerves  of  the  kid- 
nies  and  their  connection  with  the  coverings  of  the  testicle,  and 
to  notice  their  effect  in  producing  numbness  of  the  thigh  and 
retraction  of  the  scrotum  in  inflammation  of  the  gland,  when 
stones  lodge  in  the  pelvis  or  ureter. 

Upon  the  subject  of  the  sensibility  of  the  kidney,  however, 
we  must  be  aware  that  disease,  inflammation,  suppuration,  nay 
even  total  wasting  of  the  kidney  may  take  place  without  any 
indication  from  pain. 


The  excretory  duct  of  the  kidney  is  called  ureter  : it 
leads  from  the  kidney  to  the  urinary  bladder.  When  we  trace 
it  into  the  kidney  it  is  found  to  enter  the  navel-like  sulcus  of 
its  concave  side  ; here  it  is  enlarged  into  a considerable  sac 
which  is  called  the  pelvis  of  the  kidney.  This  is  a kind  of 
reservoir  which,  lying  in  the  embrace  of  the  solid  and  glandu- 
lar part  of  the  kidney,  sends  up  several  elongations  almost  like 
the  finger  of  a glove,  which  receive  into  them  the  papilke,  the 
concentrated  uriniferous  tubes.  These  processes  of  the  pelvis 
are  called  the  colices  or  infundibuli. 

It  may  be  observed,  however,  that  the  term  pelvis  is  taken 
from  the  greater  dilatation  of  the  ureter  within  the  gland, 
which  is  seen  in  brutes  ; and  that  in  man  it  is  not  so  remarka- 
ble, the  ureter  branching  with  only  a lesser  degree  of  the  sac- 
culated form  into  three  or  four  divisions,  and  these  into  the 
lesser  infundibuli. 

The  coats  of  the  ureter  are  three  in  number  ; a dense  outer 
eoat;  a middle  coat,  apparently  consisting  of  circular  muscu- 


86 


®F  THE  KIDNEY. 


lar  fibres,  though  this  has  been  denied  ; and  a smooth  inner 
coat,  (very  improperly  called  villous,)  which  secretes  a mucus 
to  defend  it  from  the  acrimony  of  the  urine.  The  ureters  do 
not  run  in  a direct  course  to  the  bladder  of  urine  ; they  take  a 
curving  direction  ; are  in  some  places  irregularly  dilated,  as 
when  they  pass  over  the  psoas  muscle,*  dropping  deep  into  the 
pelvis,  and  getting  betwixt  the  rectum  and  bladder  they  open 
obliquely  into  the  latter. 

MINUTE  STRUCTURE  OF  THE  KIDNEY. 

The  ancients,  says  Malpighi,  contented  themselves  with  the 
idea  of  a sieve,  as  conveying  a knowledge  of  the  manner  in 
which  the  urine  was  drawn  off  by  the  kidney  ; that  the  fibres 
of  its  parenchematous  matter  attracted  the  serum  of  the  blood  ; 
that  the  fibrous  matter  was  perforated  with  innumerable  fora- 
mina ; or  that  the  whole  was  a congeries  of  canals  through 
which  the  urine  was  strained  and  drawn  off.  Malpighi  set 
himself  to  refute  these  vague  opinions  by  the  minute  examina- 
tion of  the  structure  of  the  kidney  ; and  he  seems  to  have 
known  almost  all  that  we  now  know.  Though  we  do  not  ac- 
quiesce in  his  opinions  regarding  the  final  and  minute  struc- 
ture, he  describes  accurately  every  part  of  the  gland. 


Capsuhe  Renalis. 


‘The  Lobulated  ICidnies  of  the  Foetus. 


* When  the  bladder  is  contracted  in  confequence  of  a ftone,  or  when  it  is  dilated 
by  obftruction,  the  ureters  are  dilated  all'o  ; particularly  in  the  firft  cafe.  Whilft 
fhejr  are  dilated,  their  coats  become  thickened,  and  their  courfe  is  tortuous. 


OF  THE  KIDNEY. 


87 

In  the  first  place,  when  we  examine  the  outward  appearance 
of  the  kidney  of  the  fcetus,  as  in  this  annexed  plate,  we  observe 
that  it  is  not,  like  that  of  the  adult,  smooth  and  uniform  ; but 
that  it  is  tuberculated  or  lobulated  ; that  it  consists  of  distinct 
parts,  or  glands  united  together.  Again,  when  we  examine  the 
kidnies  of  other  animals,  we  find  in  several  instances  that  the 
full-grown  animal  retains  this  lobulated  form.  In  short,  it  im- 
mediately strikes  us  that  the  kidney  is  not  a uniform  mass  of 
glandular  matter,  but  that  it  must  resemble  those  glands  which 
they  call  conglobate,  and  which  consist  of  several  compartments 
or  distinct  glands  united  together. 

Accordingly  a section  of  a kidney  shows  us  that  this  is  the 
fact. 

Example  of  the  Lobulated  Kidney. 


The  ^ section  of  the  kidney  shows  us  th 
we  see  towards  the  surface  that  which  is  called 


* Explanation  of  the  annexed  plate. 

A B C D.  The  feveral  divifions  of  the  kidney  which  give  it 
figure. 

E E.  The  cortical  part  of  the  kidney,  being  the  outer,  and  it^is  fuppofed,  the 
fecreting  part. 

F F.  The  tubular  part  of  the  kidney. 

G.  The  papilla,  or  that  part  which  projects  into  the  calyx  or  divifion  of  the 
pelvis. 

H.  The  perceptible  duffs  in  the  point  or  apex  of  the  papilla. 

1 1 I.  The  other  papillae. 

L.  The  point  of  one  of  the  papilla  which  we  fee  projecting  into  the  pelvis. 

M.  The  pelvis  of  the  kidney. 

N.  B.  This  reprefents  only  one  half  of  the  kidney. 


88 


OF  THE  KIDNEY. 


glandular  part  E.  Secondly,  strise,  converging  towards  the 
centre  of  the  kidney,  being  what  is  called  the  tubular  part  of 
the  kidney.*  These  tubuli  are  divided  into  fasciculi,  taking 
a conical  shape  ; and  these  converging  unite  at  the  apex  ; two 
or  three  of  them  united  form  the  papilla.  The  papillae  are 
generally  ten  or  twelve  in  number,  or  even  more  in  each  kid- 
ney ; their  points  are  received  into  the  extremity  of  the  infun- 
dibula ; they  pour  the  urine  into  these  tubes,  and  it  is  collected 
in  the  pelvis.  Now  when  we  examine  one  of  these  papillae  in 
a lobulated  kidney,  we  find  that  it  is  the  centre  of  one  of  these 
subdivisions.  Thus, 


B 

A 


A A.  Cortical  Subjlancc*..  B.  ^Tubular  part, 

Co  Papilla . D.  D ufts. 

The  papilla  C is  merely  the  continuation  of  the  tubuli  B ; 
but  it  is  that  part  which  projects  from  the  body  of  the  kidney 
into  the  calyx  ; and  although  these  divisions  of  the  substance 
of  the  kidney  are  enumerated  as  three  distinct  parts,  the  corti- 
cal, tubular,  and  papillar  parts,  they  are  properly  only  two,  the 
cortical  and  tubular  parts. 

Some  however  have  made  a new  distinction,  by  asserting 
that  a vascular  part  is  to  be  observed  betwixt  the  cortical  and 
tubular  or  striated  parts,  as  at;*  but  it  is  not  the  case  ; for  al- 
though when  we  make  a regular  section  of  the  whole  gland, 
the  mouths  of  some  larger  vessels  will  be  observed  betwixt  the 
fasciculi  of  the  urinary  tubes,  yet  they  are  irregular  ramifica- 
tions tending  to  the  outer  cortical  part,  and  not  such  as  separate 
the  tubular  and  cortical  part,  nor  so  regular  as  to  be  considered 
as  one  of  the  subdivisions  of  the  kidney. 


* Improperly  medullary,  fometimes  striata  sulcata.  F F. 


OS  THE  KIDNEY* 


89 


OF  THE  CORTICAL  PART* 

The  external  and  cortical  part  of  the  kidney  is  by  all  allow- 
©d  to  be  the  secreting,  or,  as  they  rather  term  it,  the  secerning 
part  of  the  organ.  It  was  this  part  which  the  older  writers 
considered  as  in  a more  particular  manner  to  consist  of  a 
peculiar  fleshy  substance  of  parenchymatous  matter.  It  is  in 
this  cortical  matter  that  the  glandular  bodies  described  by 
Malpighi  are  supposed  to  be  seated.  The  appearances  whicli 
he  describes  are  to  be  very  distinctly  seen  in  many  animals  j 
for  example,  in  the  horse’s  and  cow’s  kidney  ; and  are  to  be 
seen  represented  in  these  plates.  But  he  asserted  these  bodies 
to  be  also  observable  in  the  human  kidney  ; to  demonstrate- 
which  he  ejected  a black  liquid  mixed  with  spirit  of  wine,  by 
which  the  kidney  becoming  universally  tinged,  you  may  then 
see,  he  said,  when  you  have  torn  off  the  coats  of  the  kidney, 
small  glands  partaking  of  the  colour  of  the  arteries.  These 
are  the  glands  of  the  cortical  part  of  the  kidney,  which  Mal- 
pighi described -as  hanging  upon  the  branches  of  the  arteries 
like  fruit  upon  the  pendant  branches,  and  round  which  the 
arteries  and  veins  ramified  and  convoluted,  like  delicate 
tendrils,  so  as  to  give  them  the  dark  colour  which  they  have. 

Into  these  bodies  he  supposed  the  urine  to  be  secreted,  and 
from  these  bodies  it  was  conveyed  into  the  uriniferous  ducts  or 
tubular  part  of  the  kidney  ; but  he  acknowledges  that  the  com- 
munication betwixt  the  ducts  and  glands  is  very  obscure. 

Ruysch  and  Vieussens  held  a very  opposite  opinion  regard- 
ing the  structure  of  the  kidney.*  Ruysch,  by  throwing  his 
injections  into  the  renal  arteries,  found  that  he  filled  the  urinary 
tubes,  the  ducts  of  Bellini,  and  the  pelvis  itself.  Hence  he 
conjectured  that  the  tubuli  uriniferi  or  excretory  ducts  of  the 
kidney  were  the  continued  branches  of  the  renal  artery,  with- 
out the  intervention  of  any  glandular  apparatus-! 

* Ruyfch  and  Vieuffens  long  contended  for  the  claim  of  the  difcovery  of  the 
continuation  of  the  arteries  of  the  kidney  into  the  urinary  da£b.  Ruyfch  at  firft 
acquiefced  in  the  opinion  of  Malpighi,  as  we  have  faid. 
f Thes.  Anat.  ii.  p.  gi. 


Vol.  IV. 


M 


90 


OF  THE  KIDNEY1. 


Example  of  Ruysch’s  doctrine.* 

Ruysch's  Plate . 


Kuysch  did  not  neglect  the  examination  of  the  little  bodies 
which  are  to  be  seen  in  the  cortical  substance.  He  did  not 
however  allow  they  were  glands,  but  confidently  asserted  that 
they  were  merely  the  convoluted  arteries  which  were  formed 
into  these  contorted  bundles  before  finally  stretching  out,  and 
terminating  in  the  straight  urinary  tubes. f 

* Exhibet  renis  humani  dimidiatn  partem  ita  diflfedtam,  ut  reptatus  vaforum, 
prefertim  fanguineorum,  luculentus  quam  in  precedent!  Thefauro,  tab.  iv  fig. 
iii.  videre  poffit  ; ubi  magis  inherebam,  ut  conjundtiones  arteriolarum  cum  dudti- 
bus  Bellini  exhiberern,  in  hac  autem  figura  diftindtiffime  vaforum  fanguineorum 
curium  vermicularem  per  interiorem  renis  partem  exprimere  volui. 

A.  Facies  renis  exterior  per  quam  vafa  fanguinea  reptatum  obfervant  vermi= 
cularem. 

B.  Facies  renis  interior  ubi  vafa  fanguinea  non  minus  curfum  vermicularem 
obfervant  quam  in  facie  exteriore. 

C.  Papilla;  renales. 

D.  Pelvis  renis. 

E.  Cavitas  pelvis  in  quam  papillx  urinam  (tillando  exprimunt See  The- 

faur.  Anat  W.  p.  27. 

f In  hoc  Thefauro  X.  quoque  inveniuntur  ©bjedta  renalia  ex  homine  defumpta, 
in  quibus  non  folum  luculenter  apparet  quid  judicandum  fit  de  prxtenfis  glandulis 
renalibus,  verum  etiani  quid  inveftigatoribus  renum  impofuerit,  fe  in  renibus  in. 
dagandis  fxpifiime  occurrunt  corpofcula  rotunda  glandulas  mentientia  qux  revera 
nil  funt  nifi  arteriolarum  ultimx  extremitates  contorts  ; cum  autem  exadHffime 
repkantur  arterix  renales  diifolvtntur  vel  expanduntur,  quemadmodum  fili  glo- 


QF  THE  KIDNEY. 


•91 


When  after  minute  injection  of  the  kidney  we  make  a section 
of  its  whole  substance,  we  see  vessels  emerging  from  the  more 
confused  intricate  vascularity  of  the  cortical  part,  and  running 
inward  in  striae  towards  the  papillae  ; what  we  see  there,  are, 
in  my  conception,  chiefly  veins.  And  this  I conclude,  both 
from  the  result  of  injections,  and  from  knowing  that  the  veins 
are  in  general  numerous  surrounding  the  excretory  ducts  ; 
besides  they  retain  the  blood  in  them  like  the  veins.  These 
vessels  running  in  straight  lines  and  converging  towards  the 
papillae  are  not  the  tubuli  uriniferi,  but  the  blood  vessels  accom- 
panying them,  the  tubes  themselves  being  transparent. 

Yet  I imagine  it  was  by  these  vessels  that  Ruysch  was  de- 
ceived ; for  tracing  them  from  the  extreme  arteries,  and  seeing 
them  suddenly  altered  in  their  form  and  direction,  and  run- 
ning towards  the  Papillae,  he  imagined  them  to  be  the  excre- 
tory ducts  continued  from  the  extreme  branches  of  the  arteries. 

Winslow  supposes  the  corpuscules,  which  are  seen  in  the 
cortical  part  of  the  kidney,  to  be  the  extremities  of  the  cut 
tubuli,  filled  either  with  blood  or  with  a coloured  injection. 
But  this  they  evidently  are  not ; for  by  making  the  substance 
around  them  transparent,  they  are  seen  within  the  surface,  and 
they  are  little  grains  not  the  extremity  of  tubes,  nor  extended 
in  lines. 

Boerhaave,  although  he  saw  in  the  preparations  of  Ruysch 
the  injection  passed  into  the  uriniferous  tubes,  yet  in  the  main 
favoured  the  opinions  of  Malpighi  ; and  having  sometimes 
observed  these  tubes  filled  with  injections,  while  at  intervals 
they  were  transparent  or  pale,  and  contained  only  a watery 
fluid,  he  ventured  to  conclude  that  there  was  a double  opera- 
tion going  forward  in  the  kidney  ; that  the  pale  watery  urine 
was  quickly  drawn  off  by  the  continuous  tubes ; but  that  the 
urine  of  the  other  quality  and  higher  colour  was  separated  by 
a more  perfect  and  slower  secretion  through  the  glandular 
bodies. 

In  the  history  of  opinions,  to  Boerhaave  succeeds  Berlin, 
who  writes  a long  and  laboured  paper  in  the  Memoirs  of  the 
Academy  of  Sciences  for  1744;  upon  the  whole,  he  may  be 
considered  as  endeavouring  to  prove  by  dissection  what  was 
rather  an  hypothesis  with  Boerhaave.  Benin  describes  glands 


mer,  ita  ut  nil  minus  fint,  Ccuti  dixi.  quam  partes  per  fe  fubfiftentes,  & peculiari 
membranula  obdufta;  fine  quo  immerito  dicuntur  glandulae.  Interim  confideran- 
dum  ejufmodi  contorfiones  vaforum  fang,  nufquam  in  caiteris  vifceribus  reperiri. 
In  the  epift.  to  Boerhaave,  p.  77,  we  find  Ruyl'sh  fpeaking  much  more  modeftly  : 
“ In  rene  humano  rotunda  corpufcula  efle,  faceor,  fed  funt  tarn  exilia,  ut  nihil 
poffim  definirede  illis.  Adeoque  non  b'cet  magis  dicerequod  fint  glarjdulie,  quam 
sliud  quid.’’ 


92 


OF  THE  KIDNEY. 


in  the  substance  of  the  kidney  ; but  these  he  is  careful  to  dis- 
tinguish from  the  corpuscules  of  Malpighi,  which  he  also  con- 
ceives to  be  the  extremities  of  vessels  merely. 


]VL,  Berlin  $ Plate, 


From  this  plate  we  shall  easily  understand  Bertin’s  descrip~ 
tion.  He  observes,  in  the  first  place,  that  there  are  to  be  seen 
serpentine  vessels,  such  as  Ruysch  described  : for  example,  at 
A A A,*  which  arising  at4the  circumference  of  the  cortical 
substance,  are  reflected  inward  in  a tortuous  form,  and  which, 
at  last,  approaching  the  tubular  part,  terminate  in  straight- 
tubes,  or  are  continued  into  the  tubuli  uriniferi  (for  example  at 
B B.) 

But#betwixt  the  mesches  of  vessels  which  are  described, 
and  which  are  seen  here  to  terminate  in  the  tubuli,  there  are 
beds  of  glands  C C C,  which  acervulse  of  small  glandular 
bodies  are  as  it  were  laid  in  the  tract  from  the  circumference 
towards  the  centre,  and  appear  to  terminate,  or  to  be  connected 
with  the  tubuli  uriniferi  as  the  arteries  are. 

M.  Ferrein  has  opposed  all  these  opinions  in  a paper  of  the 
Academy  of  Sciences  for  1749.  He  asserts  that  the  body  of 
the  kidney  is  neither  composed  of  glands  nor  a congeries  of 
blood  vessels  ; that  it  is  a peculiar  substance,  which  when  ex- 
amined is  found  to  consist  of  transparent  vessels.  These,  he 
says,  are  wonderfully  convoluted  in  the  cortical  part  of  the 

* Mefches  de  M.  Winflow  on  vefleaux  fpongieux  de  Vieuffens  ou  tuyaux  fef> 
gentans  de  Ruyfch, 


or  THE  KIDNEY. 


93 


kidney,  so  as  to  resemble  glands,  and  stretch  in  parallel  lines 
towards  the  papillae,  where  they  form  what  is  called  the  tubuli 
uriniferi.  Amongst  these  transparent  tubes,  the  blood  vessels 
ramify  to  great  minuteness,  and  accompany  them  where  they 
are  reflected  directly  inward  to  form  the  tubuli.  Much  ridi- 
cule, he  observes,  has  been  thrown  upon  the  term  parenchyma 
of  the  ancients  ; but  notwithstanding  he  affirms  that  there  is  in 
all  glands  a substance  dissimilar  from  the  blood  vessels,  a 
gelatinous-like  matter,  which  consists  of  or  contains  these 
pellucid  tubuli. 

Tubular  Part. — The  term  here  used  is  universally  re- 
ceived ; and  all  seem  agreed  that  the  striae  converging  to  the 
centre  of  the  kidney,  and  taking  a pyramidal  shape  are  the  ex- 
cretory ducts.  We  have  seen  that  they  were  supposed  by 
some  anatomists  to  be  formed  by  the  continuation  of  the  ex- 
treme branches  of  the  arteries  ; but  this  opinion  we  shall  ven- 
ture to  say  arose  from  the  appearance  of  the  blood  vessels  in- 
jected, which  lie  parallel  and  close  to  them.  They  are  evi- 
dently transparent  tubes,  and  probably  the  fibrous  appearance 
©f  the  whole  pyramidal  body  formed  by  them  is  owing  to  the 
accompanying  blood  vessels.  These  lesser  ducts,  as  they  ap- 
proach the  papilla;,  terminate  in  larger  ducts,  which  finally 
open  into  the  ducts  of  Bellini  at  the  point  of  the  papillae.  The 
papillae  we  have  seen  to  be  that  part  of  the  pyramidal  body 
which  projects  into  the  calyx  or  infundibulum,  and  from  their 
point  little  drops  may  be  perceived  to  run  (from  the  ducts  of 
Bellini)  when  they  are  compressed. 

I have  detailed  the  several  opinions  regarding  the  structure 
of  the  kidney  ; and  neither  do  I wish  here  to  vamp  up  an 
opinion  from  the  aggregate  of  these  contradictory  reports,  nor 
have  I been  able  to  draw  a decided  conclusion  from  my  own 
experience.  In  truth,  the  observation  from  one  dissection  I 
have  hitherto  found  so  completely  contradicted  by  other  ex- 
periments, that  I must  conclude  there  yet  remains  much  to  be 
done  in  investigating  the  minute  structure  of  the  glandular 
viscera. 

OF  THE  CAPSULE  RENALES.* 

The  renal  capsules  are  glandular-like  bodies  one  attached  to 
pach  kidney.  The  capsule  is  seated  like  a cap  on  the  upper  end 
of  the  kidney.  It  is  of  a form  like  an  irregular  crescent,  and 
suited  to  the  shape  of  that  part  of  the  kidney  to  which  it  is 
attached  ; at  the  same  time  that  it  has  three  acute  edges,  or 

* Glandule  atraiilarie  renes  ficcenturiat<r.  Glandule  renales,  &c. 


94 


OF  THE  KIDNEY. 


takes  a triangular  form. — (See  the  drawing  of  the  kidnies  of 
the  foetus.) — The  upper  edge  has  been  called  crista,  while  the 
lower  edges  have  the  name  of  lobes.  It  is  in  the  foetus  that  the 
renal  capsule  is  large  and  perfect  ; in  the  adult  it  has  shrunk, 
and  no  longer  bears  the  same  relative  size  to  the  kidney.  In 
the  foetus  the  renal  capsule  is  as  large  as  the  kidney,  and  the 
capsules  of  each  side  are  continued  into  each  other,  being 
stretched  across  the  aorta  and  vena  cava. 

The  vessels  sent  to  this  body  are  somewhat  irregular  ; they 
come  from  the  renal  or  emulgent  arteries  and  veins,  from  the 
caeliac  artery  or  phrenic,  or  from  the  trunk  of  the  aorta,  and 
even  from  the  lumbar  arteries. 

By  separating  the  lobes  of  this  body  we  find  something  like 
a cavity,  which  has  been  roundly  asserted  by  some  to  be  a re- 
gular ventricle ; by  others  altogether  denied.  Finding  a 
cavity,  they  supposed  they  must  discover  the  excretory  duct. 
Some  conceived  that  it  must  be  connected  with  the  pelvis  of  the 
kidney  ; some  with  the  thoracic  duct  ; some  with  the  testicle  ; 
but  every  thing  relating  to  the  use  of  this  body  has  hitherto 
eluded  research,  and  all  is  doubt  and  uncertain  speculation. 
For  my  own  part  I rather  conceive  that  this  body  is  useful  in 
the  foetus,  by  deriving  the  blood  from  the  kidney,  that  gland 
not  having  its  proper  office,  of  secreting  the  urine,  to  perform 
in  the  foetus. 


PART  THE  SECOND. 


OF  THE  MALE  PARTS  OF  GENERATION ; 


S there  is  no  very  accurate  division  betwixt  the  viscera  of 
the  abdomen  and  those  of  the  pelvis  ; as  the  viscera  of  the 
pelvis,  when  distended,  rise  into  the  belly,  and  are  in  every  re- 
spect like  the  abdominal  viscera,  many  have  objected  to  a divi- 
sion of  the  viscera  of  the  abdomen  and  pelvis  : nevertheless, 
there  appears  to  be  good  reason  for  this  division  of  the  subject. 
The  function  of  the  parts  is  different ; the  manner  of  their  con- 
nection is  different ; their  diseases  have  widely  different  effects. 

We  have  seen  that  the  pelvis  consists  of  the  sacrum  and  ossa 
innominata,  and  that  anatomists  have  distinguished  the  true 
and  the  false  pelvis.  The  false  pelvis  is  formed  of  the  extend- 
ed wings  of  the  ossa  ilii,  and  supports  the  viscera  of  the  abdo- 
men. The  true  pelvis,  marked  by  the  cavity  sinking  beneath 
the  promontory  of  the  sacrum  and  the  linea  innominata,  con- 
tains the  rectum  ; the  urinary  bladder  ; the  prostate  gland  ; 
the  vesiculae  seminales  ; and  part  of  the  urethra. 

The  manner  in  which  these  parts  are  connected,  and  the  ana- 
tomy of  the  urinary  bladder,  prostate  gland,  and  urethra,  will 
form  the  subject  of  the  first  section  ; while  the  anatomy  of  the 
parts  connected  with  those  of  the  pelvis  in  function,  but  seated 
without,  will  form  the  subject  of  the  second. 


( 56  ) 


CHAP.  I. 


OF  THE  PARTS  WITHIN  THE  PELVIS. 

E have  seen  that  the  abdominal  viscera  are  involved  in  a 
common  membrane  ; that  this  membrane  is  uniformly  smooth  ; 
and  that  it  has  a secretion  on  its  surface  which  bedews  the 
whole,  and  allows  the  parts  an  easy  shifting  motion  on  each 
other.  The  parts  in  the  pelvis  must  also  have  motion,  but  they 
are  at  the  same  time  more  strictly  connected  ; a loose  cellular 
membrane  is  the  medium  of  adhesion  here  : the  parts  are  im- 
bedded in  cellular  membrane,  which  is  interwoven  with  mus- 
cular fibres  towards  the  lower  opening  of  the  pelvis,  and  fur- 
ther braced  by  the  levator  ani  muscle.  This  gives  to  the 
whole  due  support ; enabling  them  to  resist  the  compression 
and  action  of  the  abdominal  muscles,  which  they  must  receive 
in  common  with  the  higher  viscera  of  the  belly. 

By  turning  to  the  first  plan  in  this  volume  we  find,  that  the 
division  of  the  parts  in  the  pelvis  and  abdomen  is  not  well  de- 
fined  ; but  we  see  that  the  peritoneum  is  reflected  from  the  pu- 
bes over  the  urinary  bladder,  and  mounts  again  upon  the  rec- 
tum. The  line  of  division,  therefore,  is  the  peritoneum  ; while 
we  understand  how  the  bladder  which  belongs  to  the  pelvis, 
being  distended,  carries  the  peritoneum  before  it,  and  rises  into 
the  abdomen. 

SECTION  I. 

or  THE  BLADDER  OF  URINE. 

As  the  general  nature  of  the  urinary  bladder  is  so  well 
known,  nothing  is  more  superfluous  than  a general  definition  or 
description.  It  is  attached  behind  the  os  pubis  ; is  nearly  of  a 
regular  oval,  when  moderately  distended,  with  the  ends  ob- 
tuse ; but  from  its  connections,  and  the  pressure  of  the  sur- 
rounding parts,  this  regular  extension  is  not  allowed  in  the 
living  body  ; it  stretches  more  laterally  ; its  fore  part  is  attach- 
ed broad  to  the  back  part  of  the  os  pubis  ; and,  behind,  it  is 
opposed  by  the  rectum.  What  the  name  would  imply  to  be 
the  lower  part,  is  above  ; for  th z fundus  of  the  bladder  is  that 
part  which,  when  distended,  rises  into  the  belly  : the  neck  is 
where  it  terminates  in  the  urethra  behind  the  arch  of  the  os 


OF  THE  BLADDER  OF  URINE. 


9? 

pubis.  When  the  bladder  is  empty,  or  contains  only  a mode- 
rate quantity  of  urine,  it  takes  a triangular  figure,  the  base  of 
which  rests  on  the  rectum,  and  the  apex  is  attached  to  the  back 
of  the  os  pubis  ; and  when  in  dissection  you  look  down  into 
the  pelvis,  you  find  the  back  part  of  the  bladder  flat,  and  as  it 
were  stretched  obliquely  up  upon  the  os  pubis. ^ 

Structure  of  the  bladder  — Like  the  other  hollow  vis- 
cera, the  bladder  consists  of  several  coats. 

The  peritoneal  coat  of  the  bladder  does  not  surround 
the  bladder,  but  only  covers  the  fundus  and  back  part.  It  is 
like  in  every  respect  to  the  peritoneal  coat  of  the  abdominal 
viscera  ; smooth  without ; and  adhering  to  the  inner  coat  by 
cellular  membrane  ; which  cellular  membrane  is,  however,  of 
a looser  texture,  and  in  greater  quantity  than  in  the  abdominal 
viscera.  This  peritoneal  coat  is  no  doubt  of  much  service  as  a 
division  in  obstructing  the  course  of  inflammation  arising  from 
the  diseases  in  the  lower  part  of  the  pelvis,  or  from  operations 
performed  on  the  bladder,  rectum,  or  perinaeum  : were  it  not 
for  the  loose  peritoneum  spreading  over  the  cellular  texture  of 
the  pelvis,  we  could  neither  be  so  bold  or  so  successful  in  our 
operations  here.  That  portion  of  the  peritoneum  which  co- 
vers the  back  part  of  the  bladder,  forms  a particular  transverse 
fold  when  the  bladder  is  contracted.  This  fold  surrounds  the 
posterior  half  of  the  bladder,  and  its  two  extremities  are 
stretched  towards  the  side  of  the  pelvis,  so  as  to  form  a kind  of 
lateral  ligament. 

Though  in  the  contracted  or  moderately  distended  state  of 
the  bladder,  the  peritoneum  stretches  from  the  back  of  the  os 
pubis  to  the  bladder,  the  distention  of  the  bladder,  in  an  immo- 
derate degree,  raises  the  peritoneum  off  from  the  pubes,  so 
that  the  bladder  can  be  struck  with  a trochar,  or  lithotomy  per- 
formed above  the  pubes,  by  an  incision  directly  into  the  blad- 
der, without  piercing  the  outer  or  peritoneal  coat. 

Towards  the  lower  part,  the  bladder,  as  we  have  seen,  is  in- 
vested only  by  cellular  membrane,  which  takes  the  place  of  tne 
peritoneal  coat  of  the  fundus.  While  we  are  aware  of  the  ef- 
fect of  the  peritoneum,  stretched  over  the  parts  in  the  pelvis, 
in  obstructing  the  progress  of  inflammation  from  the  bottom 
of  the  pelvis  towards  the  abdominal  viscera,  we  must  recollect 
that  there  exists  such  a sympathy  betwixt  the  bladder,  and  the 
stomach  and  bowels,  that  both  after  operation,  and  in  conse- 
quence of  obstruction  of  urine,  the  patient  will  sink,  in  conse- 

* This  flatnefs  of  the  bladder,  and  the  nearnefs  of  the  back  part  of  it  to  ;be  os 
pubis,  the  furgeor,  would  do  well  to  remember,  be'ore  he  thiufts  the  gorget 
ftilet  with  fuch  relentlefs  impetuolity  as  I have  feen  done. 

Vol.  IV.  " N 


( 36  ) 


CHAP.  I. 


OF  THE  PARTS  WITHIN  THE  PELVIS. 

"W E have  seen  that  the  abdominal  viscera  are  involved  in  a 
common  membrane  ; that  this  membrane  is  uniformly  smooth  ; 
and  that  it  has  a secretion  on  its  surface  which  bedews  the 
whole,  and  allows  the  parts  an  easy  shifting  motion  on  each 
other.  The  parts  in  the  pelvis  must  also  have  motion,  but  they 
are  at  the  same  time  more  strictly  connected  ; a loose  cellular 
membrane  is  the  medium  of  adhesion  here  : the  parts  are  im- 
bedded in  cellular  membrane,  which  is  interwoven  with  mus- 
cular fibres  towards  the  lower  opening  of  the  pelvis,  and  fur- 
ther braced  by  the  levator  ani  muscle.  This  gives  to  the 
whole  due  support ; enabling  them  to  resist  the  compression 
and  action  of  the  abdominal  muscles,  which  they  must  receive 
in  common  with  the  higher  viscera  of  the  belly. 

By  turning  to  the  first  plan  in  this  volume  we  find,  that  the 
division  of  the  parts  in  the  pelvis  and  abdomen  is  not  well  de- 
fined  ; but  we  see  that  the  peritoneum  is  reflected  from  the  pu- 
bes over  the  urinary  bladder,  and  mounts  again  upon  the  rec- 
tum. The  line  of  division,  therefore,  is  the  peritoneum  ; while 
we  understand  how  the  bladder  which  belongs  to  the  pelvis, 
being  distended,  carries  the  peritoneum  before  it,  and  rises  into 
the  abdomen. 

SECTION  I. 

OF  THE  BLADDER  OF  URINE. 

As  the  general  nature  of  the  urinary  bladder  is  so  well 
known,  nothing  is  more  superfluous  than  a general  definition  or 
description.  It  is  attached  behind  the  os  pubis  ; is  nearly  of  a 
regular  oval,  when  moderately  distended,  with  the  ends  ob- 
tuse ; but  from  its  connections,  and  the  pressure  of  the  sur- 
rounding parts,  this  regular  extension  is  not  allowed  in  the 
living  body  ; it  stretches  more  laterally  ; its  fore  part  is  attach- 
ed broad  to  the  back  part  of  the  os  pubis  ; and,  behind,  it  is 
opposed  by  the  rectum.  What  the  name  would  imply  to  be 
the  lower  part,  is  above  ; for  the  fundus  of  the  bladder  is  that 
part  which,  when  distended,  rises  into  the  belly  : the  neck  is 
where  it  terminates  in  the  urethra  behind  the  arch  of  the  os 


OF  THE  BLADDER  OF  URINE. 


9f 


pubis.  When  the  bladder  is  empty,  or  contains  only  a mode- 
rate quantity  of  urine,  it  takes  a triangular  figure,  the  base  of 
which  rests  on  the  rectum,  and  the  apex  is  attached  to  the  back 
of  the  os  pubis  ; and  when  in  dissection  you  look  down  into 
the  pelvis,  you  find  the  back  part  of  the  bladder  flat,  and  as  it 
were  stretched  obliquely  up  upon  the  os  pubis. ^ 

Structure  of  the  bladder  — Like  the  other  hollow  vis- 
cera, the  bladder  consists  of  several  coats. 

The  peritoneal  coat  of  the  bladder  does  not  surround 
the  bladder,  but  only  covers  the  tundus  and  back  part.  It  is 
like  in  every  respect  to  the  peritoneal  coat  of  the  abdominal 
viscera  ; smooth  without ; and  adhering  to  the  inner  coat  by 
cellular  membrane  ; which  cellular  membrane  is,  however,  of 
a looser  texture,  and  in  greater  quantity  than  in  the  abdominal 
viscera.  This  peritoneal  coat  is  no  doubt  of  much  service  as  a 
division  in  obstructing  the  course  of  inflammation  arising  from 
the  diseases  in  the  lower  part  of  the  pelvis,  or  from  operations 
performed  on  the  bladder,  rectum,  or  perinsum  : were  it  not 
for  the  loose  peritoneum  spreading  over  the  cellular  texture  of 
the  pelvis,  we  could  neither  be  so  bold  or  so  successful  in  our 
operations  here.  That  portion  of  the  peritoneum  which  co- 
vers the  back  part  of  the  bladder,  forms  a particular  transverse 
fold  when  the  bladder  is  contracted.  This  fold  surrounds  the 
posterior  half  of  the  bladder,  and  its  two  extremities  are 
stretched  towards  the  side  of  the  pelvis,  so  as  to  form  a kind  of 
lateral  ligament. 

Though  in  the  contracted  or  moderately  distended  state  of 
the  bladder,  the  peritoneum  stretches  from  the  back  of  the  os 
pubis  to  the  bladder,  the  distention  of  the  bladder,  in  an  immo- 
derate degree,  raises  the  peritoneum  off  from  the  pubes,  so 
that  the  bladder  can  be  struck  with  a trochar,  or  lithotomy  per- 
formed above  the  pubes,  by  an  incision  directly  into  the  blad- 
der, without  piercing  the  outer  or  peritoneal  coat. 

Towards  the  lower  part,  the  bladder,  as  we  have  seen,  is  in- 
vested only  by  cellular  membrane,  which  takes  the  place  of  the 
peritoneal  coat  of  the  fundus.  While  we  are  aware  of  the  ef- 
fect of  the  peritoneum,  stretched  over  the  parts  in  the  pelvis, 
in  obstructing  the  progress  of  inflammation  Irom  the  bottom 
of  the  pelvis  towards  the  abdominal  viscera,  we  must  recollect 
that  there  exists  such  a sympathy  betwixt  the  bladder,  and  the 
stomach  and  bowels,  that  both  after  operation,  and  in  conse- 
quence of  obstruction  of  urine,  the  patient  will  sink,  in  conse- 

* This  flatnefs  of  the  bladder,  and  the  nearnefs  of  the  back  part  of  it  to  the  os 
pubis,  the  furgeon  would  do  well  to  remember,  before  he  thiufts  the  gorget  er 
ffilet  with  fuch  relentlefs  impetuofity  as  I have  feen  done. 

Vol.  IV.  ‘ N 


S8 


OF  THE  BLADDER  OF  DRINK. 


quence  of  abdominal  inflammation,  without  the  direct  spread 
ing  of  the  inflammatory  action. 

Muscular  coat — The  muscular  coat  of  the  bladder  is 
, very  strong.  Three  strata  of  fibres  are  described  by  authors. 
They  are  so  strong  as  to  have  been  classed  with  the  distinct 
muscles,  and  the  whole  coat  has  been  called  detrusor  urisle. 
Towards  the  lower  part  of  the  bladder  the  fibres  are  particu- 
larly strong,  and  formed  into  fasciculi,  and  are  like  a net  of 
muscles  inclosing  the  bladder. 

Towards  the  neck  of  the  bladder  the  circular  fibres  are 
strengthened  ; and  embrace  the  beginning  of  the  urethra  ; and 
form  a sphincter,  which,  no  doubt,  is  assisted  in  its  operation 
by  the  levator  ani  muscle,  throwing  its  strong  fibres  around 
the  neck  of  the  bladder.  The  muscular  coat  of  the  bladder 
becomes  greatly  stronger,  where  difficulties  oppose  its  dis- 
charge ; and  when  there  is  a source  of  irritation,  within  the 
bladder,  acting  for  any  time,  the  whole  coats  become  thicken- 
ed, sometimes  to  the  depth  of  half  an  inch  or  more  ; in  which 
case,  as  we  have  observed,  to  take  place  in  the  stomach,  it  is 
capable  but  of  a very  inconsiderable  change,  either  by  deten- 
tion or  contraction  ; consequently  the  urine  runs  frequently  by 
painful  discharges.  The  lithotomist  would  do  well  to  distin- 
guish when  this  symptom  is  merely  the  consequence  of  a stone 
in  the  bladder,  and  when  it  is  owing  to  an  increase  in  thick- 
ness, and  a rigidity  of  the  coats  of  the  bladder  ; for,  in  the 
latter  case,  the  operation  of  the  gorget  is  attended  with  very 
serious  evils. 

We  have  an  idea  of  the  wonderful  degree  of  contraction  in 
the  bladder,  and  indeed  the  extent  of  motion  in  the  muscular 
fibre  in  general,  v/hen  we  consider  that  the  bladder  extends  so 
as  to  contain  two  pounds  of  urine,  and  contracts  so  as  to  force 
out  the  last  drop  from  its  cavity.  When,  however,  the  fibres 
are  stretched  too  far,  they  lose  the  power  of  contraction,  and 
often  the  young  surgeon  is  deceived  by  what  he  conceives  to  be 
an  incontinence  of  urine  while  it  is  really  an  obstruction. 

VASCULAR  COAT,  OR  CELLULAR  COAT. 

When  I call  this  third  coat  of  the  bladder  the  vascular  coat, 
it  is  merely  from  its  analogy  to  that  coat  of  the  intestines  which 
I have  distinguished  by  the  name  of  vascular.  Anatomists 
have  called  it  the  nervous  and  cellular  coat ; the  first  of  which 
is  quite  improper  and  the  last  apt  to  be  confounded  with  the 
surrounding  cellular  outer  coat.  This  coat  (if  coat  it  may  be 
called)  consists  of  very’  extensile  white  lamellae,  of  cellular 


OF  THE  BLADDER  OF  URINE. 


99 


membrane.  It  gives  distribution  to  a few  vessels,  and  connects 
the  muscular  fibres  and  inner  coat. 

The  internal  coat  of  the  bladder  is  very  smooth  on  its 
general  surface,  and  is  bedewed  with  a sheathing  mucus.’ 
When  the  bladder  is  distended,  no  inequalities  are  to  be  ob- 
served ; but  when  contracted  it  falls  into  folds  and  rugae. 
From  an  acrid  state  of  the  urine  ; from  strangury,  from  cal- 
culus, the  mucous  discharge  is  increased,  even  so  as  to  form  a 
great  proportion  of  the  fluid  evacuated  from  the  bladder.  No 
visible  source  of  this  mucus  is  to  be  observed  on  the  inner  sur- 
face of  this  membrane  ;*  so  that  probably  it  is  a general  dis- 
charge from  the  surface.  Indeed,  it  appears,  that  no  follicules 
or  criptse,  discharging  at  particular  points  of  the  surface, 
could  have  the  effect  of  bedewing  and  defending  the  whole 
surface  from  the  acrimony  of  the  urine.  The  great  sources  of 
the  mucus  discharged  with  the  urine  are,  the  neck  of  the 
bladder,  the  prostate  gland,  and  the  urethra.^ 

The  Ureters,  which  convey  the  urine  from  the  kidnies  to 
the  bladder  of  urine,  open  very  obliquely  into  the  bladder,  to- 
wards the  back  and  lowest  part  of  it.  The  consequence  of 
their  oblique  perforation  of  the  coats  is,  that,  the  greater  the 
tendency  of  the  urine  to  pass  retrograde  into  them  from  the 
bladder,  (there  being  a proportioned  distention  of  the  coats  of 
the  bladder,)  the  more  their  mouths  are  compressed.  Thus, 
in  the  dead  body,  there  is  no  degree  of  distention  which  causes 
the  water  to  pass  by  the  ureters.  The  contraction,  or  rather 
the  resistance  to  distention,  of  the  ureters  and  pelvis  of  the 
kidnies  seems  much  greater  than  the  powers  of  the  bladder 
are  able  to  oppose  ; for  in  obstructions  of  urine  in  the  urethra, 
there  is  still  an  incessant  accumulation  in  the  bladder,  even 
when  the  bladder  has  increased  to  such  a size  as  to  be  com- 
pressed by  the  action  of  the  abdominal  muscles.  The  cause  of 
this  yielding  of  the  bladder  to  the  secretion  of  the  kidney  is, 
that  it  has  little  permanent  contraction,  though  occasionally  its 
action  is  very  great. 

The  urachus  does  not  belong  to  the  human  bladder.  It  is 
a tube  which,  in  the  foetus  of  quadrupeds,  communicates  be- 
twixt the  bladder  of  urine,  and  the  membrane  called  alantoes. 
But  in  the  human  foetus  there  is  no  such  communication  ; both 
in  the  foetus,  and  somewhat  less  distinctly  in  the  adult,  there  is 
a ligament  like  the  remains  of  the  duct  which  runs  up  between 

* Window,  however,  defcribes  the  glands,  and  Heilter  and  Haller  dcfcribe  fol- 
licules,  near  the  neck  of  the  bladder,  and  round  the  infertion  of  the  ureti  rs. 

f When  the  mucous  fecretion  is  diminiihed  by  a difeafe  of  the  furface,  it  feems 
much  more  readiiv  to  allow  the  calculous  concretion  to  form  upon  it. 


100 


©F  THE  PROSTATE  GLAND. 


the  peritoneum  and  linea  alba  of  the  abdomen  towards  the 
umbilicus.* 


SECTION  II. 


OF  THE  PROSTATE  GLAND. 

On  the  neck  of  the  bladder,  and  surrounding  about  half  aa 
inch  of  the  beginning  of  the  urethra,  there  is  a gland  nearly  of 
the  size  and  figure  of  a chesnut.  This  body  is  called  the 
prostate  gland.  In  all  the  extent  of  anatomv,  there  is  not  a 
more  important  subject  for  the  attention  of  the  surgeon  than 
this  of  the  size,  relation  and  connection,  and  diseases  (with 
th  ir  effects)  of  the  prostate  gland:  but  to  enter  upon  these  is 
not  now  our  object. 

The  shape  of  this  body  is  round,  but  at  the  same  time 
somewhat  pyramidal,  for  it  is  broad  towards  the  bladder,  and 
points  forward.  It  has  also  a division,  forming  it  into  two 
lobes  ; and  the  older  anatomists  speak  of  it  as  double.  The 
urethra  passes  through  it , not  in  the  middle,  but  towards  its 
upper  surface  ; so  that  the  gland  is  felt  more  prominent  down- 
ward, and  is  distinctly  felt  by  the  point  of  the  finger  in  ano . 
This  gland  indeed  rests,  as  it  were,  on  the  rectum.  By  the 
annexed  drawing,)  it  is  meant  only  to  give  an  accurate  com 
ception  of  these  parts,  and  not  to  represent  them  as  they  are 
feh  in  the  living  body.  For  this  reason  the  drawing  is  made 
from  a preparation,  and  not  from  the  recent  dissection.  When 
the  catheter  is  introduced,  and  the  surgeon  examines  the  state 
of  parts  by  the  rectum,  he  will  first  distinguish  the  curve  of 
the  staff,  covered  with  the  bulb  of  the  urethra  : behind  this  the 
catheter  will  feel  more  bare  of  parts,  but  still  covered  with  a 
greater  thickness  of  parts  than  one  should  expect  from  the 
description  of  the  membraneous  part  of  the  urethra.  And 
behind  this,  again,  he  will  feel  the  prominence  of  the  prostate 
gland,  not  round,  distinct  and  accurately  defined,  but  gradu- 
ally lost  in  both  before  and  behind,  among  the  surrounding 
cellular  membrane  and  muscular  fibres  which  involve  it. 

The  texture  of  the  gland  is  a compact  spongy  substance, 
and  when  cut  has  considerable  resemblance  to  a schirrous 

* It  has  occurred,  that  the  urine  has  been  in  part  difcharged  by  the  umbilicus. 
This,  no  doubt,  isowing  to  the  ligament  remaining  permaaently  asadudt. 

+ Plates  III.  and  IV. 


STRUCTURE  OF  THE  PENIS. 


ioi 


gland.  From  each  lobe  there  are  small  follicules  opening  into 
the  urethra,  and  from  these  the  ducts  may  be  injected. 

It  has  been  said,  that  there  is  really  no  division  of  this 
gland  into  lobes : but  perhaps  the  best  authority  on  this 
question  is  disease.  Now  it  happens  sometimes  that  only  one 
side  of  the  gland  is  enlarged,  which  is  a proof  that  there  is 
some  division  betwixt  the  lobes.  This  unequal  swelling  of  the 
gland  distorts  the  urethra,  and  gives  it  a direction  very  difficult 
to  be  followed  by  the  catheter.  In  general,  when  equally 
swelled,  the  greater  part  of  the  gland,  being  beneath  the 
urethra,  raises  it  up  so  that  the  point  of  the  catheter  must  be 
raised  over  the  enlarged  gland  before  we  can  pass  it  into  the 
bladder.  This  body  is  little  liable  to  inflammation,  and  occa- 
sional tumefaction,  so  as  to  obstruct  the  urine  ; its  enlargement 
is  a chronic  state,  and  peculiar  to  advanced  age. 


CHAP.  II. 


OF  THE  PARTS  CONNECTED  WITH  THE  VIS- 
CERA OF  THE  PELVIS,  BUT  SEATED  WITH- 
OUT IT OF  THE  PENIS  AND  URETHRA.— 

OF  THU  TESTES. 


SECTION  I. 

OF  THE  PENIS  AND  URETHRA. 

STRUCTURE  OF  THE  PENIS. 

T HE  penis  consists  of  three  spongy  bodies  ; which,  being 
constituted  to  receive  the  influx  of  blood,  admit  of  distention, 
and  consequent  erection.  Two  of  these  bodies  are  called  the 
corpora  cavernosa  penis,  and  form  the  body  of  the  penis  ; 
the  other  is  the  corpus  spongiosum  urethra,  a vesicular  and 
spongy  substance,  which  surrounds  the  whole  length  of  the 


102 


STRUCTURE  OF  THE  PENIS. 


V> 

urethra,  and  expands  into  the  bulb  of  the  urethra  in  the  peri- 
neum, and  into  the  glands  on  the  point  of  the  penis. 

Corpora  cavernosa.  The  body  of  the  penis  consists  of 
two  tubes  formed  of  a very  strong  sheath.  This  sheath  has  a 
great  degree  of  elasticity,  but  at  its  utmost  extension  power- 
fully resists  the  farther  distention  with  blood.  These  tubes  are 
united  in  the  greater  part  of  the  length  of  the  penis,  or  they 
are  parted  by  an  imperfect  partition.  The  root  of  these  bodies, 
or  crura  penis,  as  they  are  called,  separate  in  the  perineum, 
so  as  so  take  hold  on  the  ramus  of  the  os  pubis.  Foreward, 
these  bodies  or  tubes  terminate  in  rounded  points  under  the 
glans  penis. 

These  tubes  are  of  a ligamentary  nature,  bating  that  they 
have  a certain  degree  of  elasticity.  They  inclose  and  support 
the  cavernous  structure  of  the  penis.  This  substance  consists 
of  cells  connected  with  each  other  and  having  a free  commu- 
nication through  the  whole  extent  of  the  penis.  These  cells 
are  interposed  betwixt  the  extremities  of  the  arteries  and 
veins,  or  probably  while  the  arteries  have  communication, 
and  open  into  the  extremities  of  the  veins,  in  the  common 
way,  they  have  such  connections  with  the  cellular  structure, 
that  in  the  accelerated  action  they  pour  their  blood  into  the 
cells  ; yet  the  blood  circulates  in  the  penis  during  erection  as 
at  other  times. 

Section  of  the  Penis  as  inflated. 


Section  of 


A,  Corpus  Cavernosum  Penis.  B,  Septum.  C,  Urethra, 
D,  Corpus  Spong.  Minus,  or  spongiosum  Urethra. 


STRUCTURE  OT  THE  PENIS. 


102, 


Corpus  spongiosum  urethra. 

Surrounding  the  urethra  there  is  a spongy  body  similar  to 
that  which  forms  the  body  of  the  penis.  Where  this  spongy 
sheath  of  the  urethra  lies  in  the  perineum,  betwixt  the  crura 
of  the  penis,  it  is  enlarged  with  a round  head,  which  is  called 
the  bulbous  part  ; — it  is  upon  this,  and  on  about  an  inch  and  an 
half  of  the  lower  part  of  the  spongy  body,  that  the  ejaculator 
seminis,  or  accelerator  urinse  acts  ; and,  as  -within  this  enlarge- 
ment of  the  spongy  body  which  surrounds  the  urethra  there  is 
also  a dilatation  of  the  tube  of  the  urethra  itself,  the  use  of  the 
muscle  is  evident.  It  contracts  upon  this  sinus  of  the  urethra 
when  distended  with  the  discharge  from  the  vesiculee,  the 
prostate  glands,  and  testicle.  As  an  accelerator  urinse,  it  can- 
not act,  but  it  expels  the  last  drop  of  urine,  as  a consequence 
of  their  detention  in  this  more  dilatable  part  of  the  urethra. 

The  spongy  sheath  of  the  urethra,  as  we  have  hinted,  is 
enlarged  into  the  gl an s,  so  that  the  action  of  the  accelerator 
muscle  affects  the  whole  length  of  the  spongy  body  of  the 
urethra  and  the  glans  by  the  compression  of  the  blood  in  the 
bulb. 

There  is  a connection  betwixt  the  glans,  spongy  tube  of  the 
urethra,  and  accelerator  muscle.  The  excitement  of  the  glans 
gives  the  action  to  the  accelerator  or  ejaculator  muscle  ; the 
action  of  this  muscle  compresses  the  bulb,  and  in  consequence 
the  whole  spongy  body  to  the  extremity  of  the  glans  is  made 
tense,  elongates,  and  contracts  the  diameter  of  the  urethra, 
adapting  it  to  the  emission  of  semen.  Mr.  Home,  I observe, 
supposes  “ that  an  action  takes  place  in  the  membrane  of  the 
urethra  during  copulation,  to  reduce  the  size  of  the  canal,  and 
fit  it  for  throwing  out  the  semen  with  the  necessary  velocity:” 
but  for  this,  there  seems  no  ground  nor  proof ; and  I imagine, 
the  action  of  the  accelerator,  and  the  state  of  distention  of  the 
spongy  body,  will  be  a good  substitute  to  his  conjecture. 

The  obtuse  point  of  the  glans  is  spread  upon  the  extremities 
of  the  cavernous  bodies  of  the  penis,  which  yet  have  no  com- 
munication with  the  glans.  We  observe  a circular  margin,  the 
corona  glandis,  and  behind  this  the  cervix.  About  the  corona 
and  cervix  there  are  many  little  glandular  follicules,^  which 
are  no  doubt  for  preserving  the  mobility  of  the  preputium. 

The  preputium  is  a loose  prolongation  of  the  integuments 
of  the  penis,  which  hangs  over  and  defends  the  delicate  and 
sensible  surface  of  the  glans.  Its  inner  surface  is  of  course 

* Glandul.  odorif.  of  Tyfon,  See  Morgagni. 


104 


STRUCTURE  OF  THE  PENIS* 


the  continued  surface  of  the  common  integuments,  while  it 
again  is  reflected  over  the  glans.  Upon  the  lower  side  the 
preputium  is  tied  in  a particular  manner  to  the  surface  of  the 
glans  behind  the  orifice  of  the  urethra.  This  connection  li- 
mits the  motion  of  the  preputium,  and  is  called  frenUm 
preputii. 

The  whole  integuments  of  the  penis  are  of  the  same  cellular 
structure  with  those  of  the  rest  of  the  body,  and  may  be  with 
equal  facility  inflated  : they  are  particularly  loose  and  distensi- 
ble, and  unincumbered  with  fat. 

A third  common  integument  of  the  penis  is  distinguished, 
and  is  called  the  tunica  nervosa.  It  is  of  a more  firm  elastic 
ligamentary  substance.  A ligament,  however,  is  not  elastic, 
and  the  firmness  here  is  merely  that  of  a greater  degree  of 
condensation  in  the  common  membrane.  It  is  this  membrane, 
which  being  attached  to  the  os  pubis,  and  supporting  the  penis, 
forms  the  ligamentum  elasticum  suspensorium. 


A Glans. 

B B Corona  Glandis. 

C Cervix. 

D Corpus  Caverno- 
fum  Penis. 

E E Corpus  Spongi- 
ofum  Urethrae. 

F Crura  of  the  Penis, 
by  which  it  is 
attached  to  the 
Ramus  of  the 
Pubes. 

H Vena  ipfius  Penis. 


STRUCTURE  OE  THE  PENIS. 


1Q§ 


OF  THE  URETHRA. 

The  urethra  is  all  that  length  of  the  canal  from  the  neck  of 
the  bladder  to  the  extremity  of  the  penis.  It  is  formed  of  the 
continuation  of  the  inner  and  third  coat  of  the  bladder,  which 
last  forms  a reticular  membrane,  uniting  the  inner  membrane 
to  the  spongy  body.  It  .is,  however,  supported  through  all  its 
length,  near  the  bladder,  by  passing  through  the  prostate  gland 
and  sphincter  fibres  ; further  forward  than  this,  where  it  passes 
from  the  prostate  to  the  beginning  of  the  spongy  body  of  the 
urethra,  it  is  invested  and  supported  by  firm  cellular  and  liga- 
mentous membranes  ; and  in  the  length  of  the  penis  it  is  in- 
cluded in  the  spongy  body,  which  extends  from  the  bulb  to  the 
glans.  It  cannot  be  described  as  a cylindrical  canal,  for  it  ad- 
mits of  very  unequal  distention.  It  begins  large  at  the  neck  of 
the  bladder,  where,  immersed  in  the  prostate  gland,  it  forms 
a little  sinus  ; it  is  contracted  again  in  a remarkable  degree 
behind  the  bulb;  it  dilates  into  the  sinus  of  the  urethra 
within  the  bulbous  enlargement  of  the  spongy  body  ; it  is 
gradually  diminished  forward  ; and  it  may  be  considered  as 
cylindrical  forward  to  the  point  of  the  glans,  where  it  is  much 
contracted,*  and  where  we  often  find  calculi  detained,  which 
have  passed  the  whole  length  of  the  canal. 

The  canal  of  the  urethra  is  bedewed  with  mucus.  The 
sources  of  this  mucus  are  here  particularly  apparent  ; for, 
besides  the  general  surface,  there  are  lai  ge  lacunae  seen  ; into 
which  the  mucus  is  secreted,  and  from  which,  as  from  recep- 
tacles, it  is  pressed  as  the  urine  flows.  The  inner  membrane 
of  the  urethra  is  very  delicate,  and,  when  torn  bv  the  catheter, 
or  by  violent  chordee,  or  opened  by  the  caustic,  bleeds  pro- 
fusely. 

The  internal  membranes  of  the  bladder  and  urethra  are 
particularly  sensible  ; drawing  after  them,  when  excited,  not 
only  the  action  of  all  the  muscles  in  the  lower  part  of  the  pelvis, 
but  having  sympathies  in  a particular  manner  with  the  testicle, 
stomach,  and  bowels,  and  with  the  whole  system.  The  more 
curious  and  important  effect  of  the  injurvof  the  urethra  is  the 
paroxysm  of  fever  which  it  induces.  Observing  the  regular 
occurrence  of  an  intermitting  fever  in  cases  of  fistula  in  the 
perineum,  we  should  imagine  it  to  be  the  effect  of  the  extra- 
vasation of  the  urine  in  the  cellular  membrane,  and  the  effect 
of  general  irritation  ; until  it  is  observed  that  the  simple 


* Haller  Cam.  lib.  xxvii.  £e<ft.  i.  § xxx,  Mr.  Home’s  Strictures. 

Vol.  IV,  O 


106 


STRUCTURE  OF  THE  PENIS. 


stricture  produces  that  effect,  and  that  a touch  of  the  caustic 
brings  on  a violent  paroxysm. 

When  the  reticular  membrane  is  inflamed,  of  course  it  loses 
its  elasticity,  and  gives  pain  in  erection.  Sometimes  the  in- 
flammation, being  continued  to  the  spongy  body  surrounding 
the  urethra,  makes  it  unequal  in  its  capacity  of  distention  to 
the  cavernous  bodies  of  the  penis,  and  sometimes  their  cells  are 
united  by  adhesion  in  the  worst  cases  of  chordee. 

I cannot  imagine  with  some,  that  the  urethra  is  muscular  ; 
first , because  I see  no  end  it  could  serve  in  the  ceconomy  ; 
secondly , because  there  is  no  proof  in  support  of  the  opinion  ; 
thirdly,  because  it  is  surrounded  with  strong  fibres  and  a 
spongy  body,  which  conjointly  seem  calculated  for  every  pur- 
pose of  the  ceconomy,  and  likely  to  account  for  every  symptom 
which  might  be  mistaken  for  spasmodic  action  in  the  canal  it- 
self. The  idea  of  muscularity  is  derived  from  the  symptoms 
of  stricture  and  irritability  of  the  canal.  I shall  therefore,  iu 
the  first  place,  shew  how  I conceive  stricture  is  produced. 

The  urethra  is  very  elastic  ; not  only  allowing  a very  large 
bougie  to  be  passed,  and  closing  upon  a thread,  but  it  still 
more  remarkably  admits  of  elongation  than  of  distention  in  the 
width  of  the  canal.  It  is  surrounded,  as  we  have  seen,  with 
a spongy  body  and  the  cellular  coat  which  is  betwixt  the  deli- 
cate lining  membrane  of  the  urethra,  and  the  spongy  bodt' 
partakes  of  the  structure  of  both,  and  is  very  elastic.  But 
when  an  inflammation  attacks  the  canal,,  this  cellular  mem- 
brane is  its  principal  seat.  The  point  affected  loses  its 
elasticity  ; no  longer  stretches  with  the  penis  and  urethra,  but 
consolidates,  and  throw’s  the  inner 
membrane  into  a fold  in  a direction 
across  the  canal.  Thus  the  mem- 
brane at  A has  contracted  and  con-  a 
densed  in  consequence  of  inflamma- 
tion, or  rather,  when  contracted  by  B 
the  shrinking  of  the  urethra  in  length 
and  its  spongy  body  has  formed  an 
adhesion,  and,  in  consequence  of  in- 
flammation, has  lost  its  elasticity  and 
no  longer  dilates  in  the  proportion  of 
the  rest  of  the  canal.  The  conse- 
quence of  this  is,  that  the  point  of  the 


inner  membrane  B makes  a projecting  ring  round  the  urethras. 
To  suppose  this  stricture  to  have  been  formed  by  the  muscular 


STRUCTURE  OF  THE  PENIS. 


107 


contraction  in  the  diameter  of  the  canal, * would  be  to  allow 
the  partial  action  of  one  or  two  fibres  ; (for  the  stricture  is  like 
that  which  would  be  produced  by  the  tying  of  a pack-thread 
round  the  canal,  being  a narrow  circular  ridge  ;)  which  is  very 
unlikely.  Sometimes,  however,  the  stricture  is  only'  on  one 
side  of  the  canal,  which,  allowing  it  to  be  formed  as  I have 
here  supposed,  is  very  likely  to  happen  : but  in  consequence 
of  the  muscular  action,  cannot  easily  be  supposed  to  take 
place,  since  the  drawing  of  the  muscular  fibres  would  equally/ 
affect  the  whole  circle. 

As  to  the  effect  of  heat  and  cold  on  an  obstruction,  it  may 
be  explained  simply,  without  the  supposition  of  muscular  con- 
traction : for  as  we  know  that  the  penis,  spongy  bodies,  and 
of  course  the  whole  canal,  relax  and  elongate  in  warmth,  as 
they  are  shrunk  up  and  contracted  in  cold,  like  the  skin  of  the 
body  in  general,  without  implying  muscular  contraction  : so 
we  see  how  this  state  would  affect  a stricture  ; — that,  when  the 
penis  and  the  urethra  was  shrunk,  the  effect  of  the  stricture 
would  be  increased,  and  the  patient  could  pass  his  urine  only 
when  the  parts  were  relaxed,  by  sitting  in  a warm  room,  or  by 
the  use  of  the  bath. 

But  when  surgeons  speak  of  spasms  of  the  urethra,  they 
seem  to  forget  the  action  of  the  surrounding  muscles.  Thus 
acrid  and  stimulating  urine,  or  an  irritable  state  of  the  urethra, 
will  be  followed  by  a small  stream  of  urine  : or  perhaps  a 
temporary  obstruction  is  the  consequence  : but  why  should  we 
suppose  that  the  membrane  of  the  urethra,  which  has  no  ap- 
pearance of  muscularity,  causes  this  effect,  when  it  is  probably 
produced  by  the  sphincter  muscle,  the  fibres  which  surround 
the  membraneous  part  of  the  urethra,  the  levator  ani,  and, 
above  all,  by  the  accelerator  urinae,  a muscular  sheath  of  fibres 
surrounding  three  or  four  inches  of  the  canal.  Round  the 
membraneous  part  of  the  urethra,  and  behind  the  bulb,  there 
is  much  interlacing  of  muscular  fibres ; and  the  levator  ani, 
splitting,  embraces  it.  Round  the  sinus  of  the  urethra  and  the 
bulb  which  covers  it,  is  the  accelerator  urinae,  more  properly 
the  ej  aculator  seminis : and  as  the  ejaculator  seminis  contracts 
upon  the  sinus,  it  drives  onward  the  semen  along  the  urethra, 
since  the  seminal  fluids  do  not  pass  backward  into  the  bladder, 
unless  when  the  action  of  the  parts  is  much  disordered  ; there 
must  be  a contraction  round  the  urethra  behind  the  bulb  during 
the  action  of  the  ejaculator.  The  sensibility  of  the  glans 

* lt  A ftricture,”  fays  Mr.  Home,  “ whether  in  the  fpafmodic  or  permanent 
date,  is  a contraction  of  the  trarifverfe  fibres  of  the  membrane  which  forms  the 

-:annV  ’ 


108 


OF  THE  TESTES. 


holds  a controul  over  the  action  of  these  muscles  ; and  the 
d st  ase  of  the  bladder  and  of  these  parts  affects  the  glans. 
There  is,  in  short,  a complicated  apparatus  here,  and  we  can- 
not wonder,  that  the  most  frequent  seat  of  disease  is  just  at 
the  beginning  of  the  sinus  of  the  urethra,  where  the  muscular 
action  is  stronger,  and  the  canal  narrowest.  At  this  place  is 
the  stricture  of  the  urethra  most  common,  and  here  if  spasm 
and  muscular  action  should  bring  it  on,  if  spasmodic  action 
should  prevail  during  the  permanent  stricture,  or  blistering 
bring  on  a strangury,  (seeing  that  this  point  is  so  surrounded 
with  muscular  fibres  destined  to  a particular  action,)  we  must 
not  take  these  symptoms  as  indicating  a muscularity  in  the 
whole  tract  of  the  urethra.  I believe  it  is  found,  that  stricture 
is  most  frequent  just  behind  the  bulb  of  the  urethra  ; where  I 
have  alleged,  the  muscularity  is  greatest ; and  also  about  the 
distance  from  the  extremity  of  the  urethra  which  answers  to 
the  termination  of  the  ejaculator  muscle. 


SECTION  II. 


OF  THE  TESTES. 

The  testicle  might  be  considered  as  more  naturally  con- 
nected with  the  abdominal  viscera,  than  with  those  of  the 
pelvis,  as  its  original  seat  is  on  the  loins  amongst'the  abdominal 
viscera,  and  as  it  receives  its  coats  from  the  peritoneum,  and 
its  vessels  from  the  abdominal  vessels. 

The  testes  are  two  glandular  bodies  which  secrete  the  se- 
men : they  receive  their  vessels  from  the  aorta  and  cava,  or 
the  emulgent  vessels  ; their  excretory  duct  runs  up  into  the 
belly,  and  it  terminates  in  the  urethra  near  the  neck  of  the 
bladder. 

The  scrotum,  in  which  the  testicles  are  lodged,  is  a con- 
tinuation of  the  common  integuments  ; its  cellular  membrane 
is  particularly  lax  and  free  from  fat,  and  anasarca  extremely 
apt  to  fall  down  into  it,  so  as  sometimes  to  distend  the  scrotum 
to  a transparent  bag  of  enormous  size  ; and  not  unfrequently 
it  has  been  blown  up  to  counterfeit  rupture  and  other  diseases. 

The  cellular  substance  of  the  scrotum  is  peculiar  in  its  ap- 
pearance, being  red  and  fibrous.  It  has  been  considered  as  a 
muscle,  and  called  dartos  : although  this  is  denied  by  many. 
Its  action  is  to  support  and  brace  the  scrotum  ; and  in  bad 
health,*  and  iii  old  age,  it  is  so  much  relaxed  as  to  allow  the 

* Nurfes  particularly  attend  to  the  ftate  of  the  ferotum  in  children. 


OP  THE  TESTES. 


109 


testicles  to  hang  upon  the  chords.  But  besides  the  simple  cor- 
rugation and  relaxation,  the  scrotum  has  a motion  like  the 
vermicular  motion  of  the  intestines,  from  side  to  side,  and 
alternately.  Its  contraction  has  a relation  to  the  healthy  secre- 
tion of  the  gland  within. 

Upon  the  surface  of  the  scrotum,  directly  in  the  middle, 
there  is  a line  passing  from  the  lower  part  of  the  penis  to  the 
anus  ; the  rapha.  This  line  marks  a division  in  the  scrotum, 
not  superficial  merely  ; but  a partition,  or  septum,  is  formed, 
dividing  the  scrotum  into  two  distinct  cellular  beds  for  the 
testicles. 

Coats  of  the  testicle.  Besides  the  involving  scrotum, 
each  testicle  has  two  distinct  coats,  the  tunica  vaginalis  and 
tunica  albuginea.  The  tunica  vaginalis  covers  the  testicle 
loosely  ; that  is,  without  adhering  to  its  general  surface  ; but 
the  albuginea  is  in  close  union  with  it,  and  is  the  immediate 
coat  of  the  testicle.  The  inner  surface  of  the  vaginal  coat  is 
perfectly  smooth,  and  an  exudation  is  poured  out  from  it,  as 
from  the  peritoneum  within  the  belly,  the  outer  surface  of  the 
tunica  albuginea  is  also  smooth  and  firm,  and  white,  whence 
its  name.  But  on  its  inner  surface,  like  the  peritoneum,  which 
covers  the  intestine,  and  adheres  to  the  muscular  coat,  it 
adheres  to  the  tubes  of  the  testicle  itself.  These  investing 
coats  are  in  some  respects  dissimilar,  yet  in  general  much 
alike,  being  continuations  of  the  same  membrane,  and  both 
prolongations  of  the  peritoneum.  The  outer  membrane,  the 
tunica  vaginalis,  is  a protection  to  the  testicle,  gliding  easily 
on  the  inner  coat,  and  with  the  mobility  of  the  cellular  mem- 
brane of  the  dartos  it  preserves  the  testicles  from  bruises  and 
strokes  to  which  it  would  be  exposed  if  it  were  more  firmly 
attached.  The  inner  tunic,  or  albuginea,  gives  strength  and 
firmness  to  the  substance  of  the  testicle.  Betwixt  these  coats 
is  the  fluid  collected,  which  forms  the  hydrocele.  They  also 
contain  the  congenital  hernia  ; but  the  common  hernia  is  with- 
out both  coats  of  the  testicle.  To  understand  the  principles  of 
anatomy  of  this  part,  we  must  attend  to  the  descent  of  the 
testicle,  and  to  the  manner  in  which  these  coats  are  formed. 

of  the  descent  of  the  testicle. 

In  the  fcEtus,  some  months  before  birth,  the  testicles  are 
lodged  in  the  belly,  and  are  in  every  respect  like  the  abdominal 
viscera.  They  are  seated  on  the  fore  part  of  the  psoae  muscles, 
by  the  side  of  the  rectum.  They  are  of  course  covered  and 
invested  by  the  peritoneum  ; for,  as  we  have  explained  how 
the  solid  viscera  and  the  intestines  are  behind  the  peritoneum, 


110 


or  THE  TESTES. 


so  it  will  be  understood  how  the  testicles  lying  on  the  loins  are 
behind  the  peritoneum  : that  is  to  say,  the  glandular  substance 
of  the  testicle  is  invested  by  a single  coat,  and  that  coat  is  the 
peritoneum,  which,  alter  covering  the  body  of  the  testicle,  is 
reflected  upon  the  loins  ; as  the  coats  of  the  liver,  for  example, 
are  to  be  traced  from  its  surface  to  the  diaphragm  : no  words, 
however,  can  well  explain  this  subject,  and  it  will  be  better 
understood  by  sections  and  plans. 

First  Plan  of  the  Testicle. 

• ist  Plan  of  the  Tefticle. 


We  see  that  the  body  of  the  testicle  A is  seated  on  the  loins, 
that  it  is  attached  by  vessels,  and  invested  by  the  peritoneum. 
This  surrounding  of  the  body  of  the  testicle  by  the  peritoneum 
forms  that  coat  which  is  in  union  with  its  substance,  and  which 
descends  with  it  into  the  scrotum,  and  forms  the  tunica  al- 
buginea. 

The  figure  and  presenting  surfaces  of  the  testicle,  while 
within  the  belly,  are  the  same  which  we  find  after  it  has  de- 
scended into  the  scrotum.  It  stands  edge-ways  forward,  and 
the  epididimis  lies  along  the  outside  of  the  posterior  edge  of 
the  testes.  We  see  that  it  is  attached,  by  the  peritoneum 
being  reflected  off  from  its  back  part,  and  we  can  trace  the 
peritoneum  upwards  over  the  kidnev  G,  and  downward  over 
the  rectum  F,  and  bladder  of  urine  E. 

We  may  also  observe  a process  of  the  peritoneum  which  has 


OF  THE  TESTES. 


lit 


passed  through  the  abdominal  ring,  and  which  in  this  plan  is 
marked  D.  Now  it  may  easily  be  understood  that  the  testicle 
A,  gradually  shifting  its  place  from  its  connections  in  the 
loins,  drops  down  into  this  sheath  D.  It  will  also  be  easily 
understood  how  the  testicle  covered  with  its  first  coat  B,  (viz. 
the  tunica  albuginea,)  when  it  has  fallen  into  D,  is  invested  by 
this  sac  of  the  peritoneum,  and  that  this  last  covering  will 
come  to  be  the  tunica  vaginalis.  The  tunica  vaginalis  is  so 
called  because  it  covers  the  testicle  like  a sheath  ; that  is,  it 
does  not  universally  adhere  to  the  surface  of  the  albuginea,  as 
that  coat  does  to  the  body  of  the  testicle. 

Understanding  the  nature  of  the  peritoneum,  we  may  learn 
the  meaning  of  this  looseness  of  the  outer  coat  of  the  testicle. 
By  turning  to  the  introductory  section  of  the  abdominal  mus- 
cles, we  find,  that  the  inside  of  the  sac  of  the  peritoneum  is 
smooth,  and  forms  no  adhesion  ; whilst  the  outer  surface, 
being  in  contact  with  the  substance  of  the  several  viscera,  has 
a connection  with  them  by  a common  cellular  membrane. 
Now,  as  the  inside  of  the  peritoneum  does  not  adhere,  as  the 
surface  of  the  peritoneum,  (which  in  this  first  plan  is  towards 
C,)  is  smooth,  and  has  no  tendency  to  unite  with  the  surface 
of  the  viscera  ; so  neither  has  the  surface  of  the  peritoneum 
at  D,  the  tendency  to  unite  with  the  peritoneum  (or  the  sur- 
face of  the  albuginea,)  at  B,  when  it  descends  to  meet  it : 
consequently  the  coat  of  the  intestines  may  be  represented  in 
this  second  plan,  thus. 

Second  plan  of  the  Testicle- 


3d.  Plan  of  the  Teftide.  3d.  Plan  of  the  Tefticle, 


112 


or  THE  TESTES. 


In  the  first  plan,  we  had  the  situation  of  the  testicle  in  the 
foetus  represented.  In  the  second  plan,  we  have  the  middle 
stage  of  the  descent  represented : and,  in  the  third,  we  have 
the  full  descent.  In  the  second  figure,  A is  the  body  of  the 
testicle,  B is  the  first  peritoneal  covering  or  tunica  albuginea, 
which  can  be  easily  traced,  reflected  off  from  the  loins  at  C; 
again,  D is  the  portion  of  the  peritoneum,  which  having  de- 
scended before  the  testicle  is  presently,  when  the  testicle  has 
fully  descended,  to  become  the  second,  or  vaginal  coat  of  the 
testicle  ; F is  the  continuation  of  the  peritoneum  upon  the 
inside  of  the  abdominal  muscles. 

In  the  third  figuie  of  this  series,  we  find  the  testicle  A has 
descended  into  the  scrotum  ; that  it  has  one  coat  covering  it, 
which  we  recognize  to  be  the  same  with  B,  in  the  first  figure, 
and  that  the  peritoneum  in  this  third  plate  at  B,  can  be  traced 
to  C,  the  peritoneum  within  the  belly. 

Now  supposing  this  to  be  the  state  of  the  testicle  immedi- 
ately after  it  has  descended,  we  see  that  there  is  still  a com- 
munication betwixt  the  cavity  of  the  tunica  vaginalis  D,  and 
the  cavity  of  the  peritoneum  E.  F is  the  kindey,  covered  by 
the  peritoneum,  and  nearly  in  the  situation  in  which  the  testi- 
cle was  before  its  descent. 


Fourth  Plan  of  the  Testicle. 


From  this  fourth  plan  of  the  testicle,  we  may  learn  the 
nature  of  the  congenital  hernia.  It  is  a hernia  produced  by 


OF  THE  TESTES. 


113 


ihe  intestine  slipping  down,  from  the  communication  betwixt 
the  general  cavity  of  the  peritoneum,  and  the  cavity  of  the 
tunica  vaginalis,  or  in  consequence  of  an  adhesion  betwixt  the 
testicle  and  a portion  of  the  gut,  which  of  course  causes  the 
gut  to  follow  the  testicle,  and  prevents  the  communication  be- 
twixt the  belly  and  the  cavity  of  the  tunica  vaginalis  from  being 
shut.  Thus,  fig.  4.  A,  is  the  testicle,  as  it  is  seen  in  plan  3d. 
B,  the  tunica  albuginea;  C,  the  peritoneum  within  the  belly ; 
D,  the  tunica  vaginalis,  which  we  can  trace  from  C,  and  which 
is  distended  and  separated  from  the  surface  of  the  testicle, 
(i  e.  of  the  albuginea)  by  a portion  of  the  gut,  which  has  de- 
scended through  the  ring:  F,  the  intestines  within  the  belly: 
G,  the  intestine  which  has  fallen  into  the  tunica  vaginalis,  and 
is  in  contact  with  the  testicle  ; that  is,  in  contact  with  the  tuni- 
ca vaginalis,  which  is  in  close  union  with  the  gland,  and  is  con- 
sidered as  its  surface. 

We  have  explained  the  change  which  takes  place  in  the  situ- 
ation of  the  testicle,  as  it  relates  to  the  peritoneum  ; but  how 
this  change  is  brought  about,  it  is  very  difficult  to  understand. 
It  is  not  a sudden  pulling  down  of  the  testicle,  but  a very  gra- 
dual process,  continuing  for  months  ; it  is  not  the  effect  of  gra- 
vitation, for  the  fetus  may  be  in  every  variety  of  posture  while 
in  the  womb,  and  generally  the  head  presents.  It  is  not  respi- 
ration. Is  it  then  the  effect  of  the  action  of  the  cremaster  mus- 
cle ? or  must  we  refer  it  to  a law  such  as  that  which  controuls 
and  directs  the  growth  of  parts  ? 

When  the  parts  in  a fetus  before  the  descent  of  the  testicle 
are  dissected,  there  is  found  a ligamentous,  or  cellular  cord, 
mingled  with  the  fibres  of  the  cremaster  muscle,  and  which 
takes  its  origin  from  the  groin,  is  reflected  into  the  abdominal 
ring,  and  stretches  up  to  the  body  of  the  testicle.  This  body 
is  called  ligament  or  gu'oernaculum,  and  to  the  agency  of  this 
bundle  of  fibres,  is  the  descent  of  the  testicle  attributed. 
There  are,  however,  objections  to  this.  If  we  suppose  that 
the  cremaster  muscle,  by  its  exertion,  brings  down  the  testicle 
to  the  ring,  how  does  it  pass  the  ring  ? for  surely  we  cannot 
suppose  that  this  muscle,  which  takes  its  origin  from  the  inter- 
nal oblique  muscle,  consequentlv  within,  can  contract,  not  only 
so  as  to  bring  the  testicle  to  the  very  point  of  its  origin,  but  to 
protrude  it  past  that  point,  and  through  the  tendon  of  the  ex- 
ternal oblique  muscle.  Again,  animals  have  the  cremaster 
muscle,  whose  testicles  never  descend  out  of  the  bellv ; — again, 
the  vessels  of  the  chord,  before  the  testicle  has  fully  descended, 
show  no  marks  of  being  dragged  down,  for  they  are  elegantly 
tortuous. 

As  the  testicle  passes  verv  slowly  from  the  loins  to  the  ring  ; 
Vol.  IV.  ' P 


114 


OF  THE  TESTES. 


so,  after  it  has  escaped  from  the  belly,  it  passes  slowly  from  the 
ring  to  the  bottom  of  the  scrotum.  It  commonly  remains 
some  time  by  the  side  of  the  penis,  and  only  by  degrees  de- 
scends to  the  bottom  of  the  scrotum.* 

In  this  change  the  testicles  do  not  fall  loose  into  the  elonga- 
tion of  the  peritoneum  like  a piece  of  gut  or  omentum  in  a 
rupture  ; — but,  carrying  the  peritoneum  with  them,  they  conti- 
nue to  adhere  to  the  parts  behind  them,  as  they  did  to  the  psoas 
muscle  while  in  the  loins  : a point  of  importance  to  be  recol- 
lected by  the  young  surgeon. 

The  communication  betwixt  the  belly  and  the  sac  of  the  va- 
ginalis is  very  soon  obliterated  by  the  adhesion  of  the  upper 
part,  and  then  the  whole  extent  of  the  passage  (viz.  from  E. 
to  E).  in  plan  3d  of  this  series,)  is  shut.  When  this  process  is 
prevented  in  the  first  instance,  when  nature  is  baulked  in  the 
humour  of  doing  her  work,  as  Mr.  Hunter  observes,  she  can. 
not  so  easily  do  it  afterwards. 

It  has  also  occurred  that,  this  communication  remaining  af- 
ter birth,  a hydrocele  has  been  produced  by  the  distention  of 
the  tunica  vaginalis,  by  fluids  descending  from  the  belly.  The 
character  of  such  a tumour  will  be,  that  the  fluid  will  be  easily 
forced  into  the  belly.  It  may,  however,  be  mistaken  for  a con- 
genital hernia. f 

It  will  already  be  understood,  that  in  the  common  hernia  of 
the  groin  or  scrotum,  the  gut  does  not  pass  by  the  communica- 
tion from  the  belly  into  the  vaginal  coat ; that  such  communi- 
cation no  longer  exists,  and  that  when  there  is  a rupture  from 
preternatural  wideness  of  the  abdominal  ring,  or  in  conse- 
quence of  a great  violence,  a new  portion  of  the  peritoneum  de- 
scends with  the  gut  before  the  chord  of  the  testicle. 

" Mr.  Hunter  has  {hewn,  that  the  detention  of  the  tefticle  in  the  belly  is  in  corr- 
fequcnce  of  fome  defetft  and  want  of  adtion  in  the  tefticle.  and  that  thofe  who 
have  the  tefticle  remaining  in  the  belly  have  it  imperfedf  or  fmall.  This  is  con- 
trary to  an  old  authority  : — I he  tefticles  are  feated  externally,  “ for  chaftity’s 
fake,  for  fuch  live-wights  as  have  their  ftones  hid  within  their  body,  are  very  lech- 
erous, do  often  couple,  and  get  many  young  ones.” 

t Such  is  the  remark  of  Mr.  Hunter. 


OF  THE  TESTES, 


115 


Fifth  Plan  of  the  Testicle . 


Hernia. 


This  5th  plan  will  now  illustrate  the  relation  of  the  testicle 
to  the  herniary  sac  in  the  common  scrotal  hernia.  A,  the  scro- 
tum : B,  the  testicle  ; which  will  be  easily  understood  to  pre- 
serve its  attachment  to  the  back  part  of  the  scrotum  : C,  the 
tunica  vaginalis,  which  here  invests  the  testicle,  but  which  is 
not  now  (in  the  adult  or  perfect  state  of  the  coats  of  the  testi- 
cle,) as  is  seen  in  plan  3d,  open  from  D to  E,  but  forms  a short 
sac  surrounding  the  tunica  albuginea : D,  the  cellular  mem- 
brane of  the  chord  of  vessels  passing  down  to  the  testicle.  And 
now  there  are  no  remains  of  the  tube  of  communication  be- 
twixt the  belly  and  vaginal  cavity  ; it  is  obliterated  and  resol- 
ved into  this  cellular  membrane. 

We  see  then,  that  in  this  plan  the  testicle  and  its  coats,  and 
the  spermatic  chord,  are  in  their  natural  situation,  and  that  the 
herniary  sac  has  descended  before  them.  E,  is  the  ring  of  the 
external  oblique  muscle  of  the  abdomen,  through  which  not 
only  the  testicle,  with  its  coats  and  vessels,  has  descended,  but 
also  the  hernia  : F,  the  herniary  sac,  which  contains  a portion 
of  the  gut  ; it  is  formed  of  the  peritoneum,  fallen  down  from 
the  belly,  but  it  is  quite  distinct  from  the  sac  of  the  tunica  vagi- 
nalis C.  Whilst  this  new  process  of  the  abdominal  peritone- 


116 


©F  THE  TESTES, 


um  has  descended,  it  has  contracted  adhesions,  and  cannot  now 
be  replaced. 

In  thus  explaining  these  important  principles  of  anatomy, 
and  which  the  anatomical  student  will  find  wonderlully  to  faci- 
litate the  more  minute  study  of  surgical  anatomy,  it  only  re- 
mains to  show  the  nature  of  the  hydrocele. 

The  hydrocele  is  a collection  of  water  within  the  sac  of  the 
tunica  vaginalis  ; that  is,  betwixt  the  tunica  vaginalis  and  tuni- 
ca albuginea.  For,  as  we  have  seen,  that  the  same  surface  of 
the  vaginal  coat  is  contiguous  to  the  surface  of  the  testicle 
(viz.  the  albuginea,)  with  that  of  the  peritoneum,  which  is 
contiguous  to  the  viscera  of  the  belly  ; and  as  it  has  the  same 
exudation,  so  it  has  the  same  disease,  viz.  a collection  of  water, 
from  the  absorption  being  disproportionate  to  the  exudation. 
When  the  tunica  vaginalis  is  distended  with  the  water  of  a hy- 
drocele, the  testicle  is  towards  the  back  part  o.f  the  scrotum  ; 
it  can  he  felt  there  ; and  when  the  scrotum  is  placed  betwixt  the 
candle  and  the  eye,  we  see  the  transparent  sac  on  the  fore  part 
of  the  tumour,  the  opaque  mass  of  the  testicle  behind  ; gene- 
rally the  distended  vaginal  coat  stretches  up  before  the  chord, 
conically.  Thus, 


A,  the  penis  ; it  is  generally  corrugated  thus,  in  consequence 
of  the  distention  of  the  scrotum  in  scrotal  hernia  and  hydro- 


Sixth  Plan  of  the  Testicle . 

Hydrocele. 


1 


OF  THE  TESTES. 


117 


cele  : B,  the  scrotum  : C,  the  testicle,  covered  only  by  the  tu- 
nica albuginea  ; D,  the  cellular  membrane  of  the  chord  : E,  the 
tunica  vaginalis,  distended  with  the  water  of  the  hydrocele, 
and  consequently  separated  from  the  surface  of  the  testicle  : 
F,  that  part  of  the  sac  of  the  vaginal  coat,  which  often  extends 
conically  before  the  cellular  membrane  of  the  chord  D.  Now 
we  see  that  the  distention  of  the  vaginal  coat  does  not  open  up 
the  old  communication  with  the  belly  ; but  that,  the  former 
communication  being  shut,  and  the  peritoneum  there  degene- 
rated into  the  cellular  membrane  of  the  chord,  the  hydrocele  is 
a distinct  sac,  surrounding  the  testicle,  and  formed  of  the  tuni- 
ca vaginalis. 

To  understand  this  subject  of  the  coats  of  the  testicle,  it  is 
not  necessary  merely  to  consider  the  descent  of  the  testicle  ; 
but  the  student  must  consider  it  in  every  point  of  view,  turn  it 
as  it  were  into  every  variety  of  posture,  without  which  his  dif- 
ficulties will  perpetually  return  upon  him.  It  is  for  this  reason 
that  I have  endeavoured  to  represent  simply  the  various  states 
sf  the  coats  of  the  testicle  in  disease. 

OF  THE  VESSELS  OF  THE  CHORD  AND  TESTICLE. 

In  attending  to  the  descent  of  the  testicle,  we  have  a cue  al- 
so to  the  vascular  system.  If  we  did  not  know  that  the  testi- 
cles were  originally  placed  in  the  loins  within  the  belly,  we 
might  wonder  at  the  length  and  origin  of  the  spermatic  ves- 
sels. 

The  spfrmatic  artery  rises  from  the  fore  part  of  the 
aorta,  below  the  emulgent  arterv,  or  from  the  emulgent  artery, 
(generally  on  the  right  side,)  and  sometimes  from  the  arteries 
of  the  renal  capsule  ; sometimes  there  is  only  one,  sometimes 
there  are  two  spermatic  arteries.  This  artery,  which  the  chord 
receives  from  the  aorta  or  emulgent,  is  called  the  superior  sper- 
matic artery,  because  there  is  another  which  rises  from  the  hy- 
pogastric artery  : this  branch  runs  upward,  connected  to  the 
vas  deferens,  as  it  rises  out  of  the  pelvis. 

These  arteries,  taking  their  course  under  the  peritoneum, 
join  the  fasciculus  forming  the  chord,  and  supply  thechord,and 
send  twigs  to  the  investing  peritoneum ; they  then  pass  through 
the  abdominal  ring,  and  in  their  course  they  are  beautifully  tor- 
tuous. 

The  veins  of  the  testicle  rise  on  the  right  side  from  the 
trunk  of  the  cava,  a little  below  the  emulgent  vein,  and  from 
the  emulgent  vein  on  the  left  side.  In  the  origin  of  these  veins 
there  are  frequent  varieties  ; there  is  also,  accompanying  the 
vas  deferens,  a vein,  which  joins  the  internal  iliac  vein.  These 


118 


OF  THE  TESTES. 


veins,  in  their  course  from  the  testicle,  are  protected  from 
the  column  of  blood,  and  from  the  bad  consequences  of  com- 
pression, by  numerous  valves.  These  valves  are  very  strong, 
and  will  bear  a great  column  of  mercury  before  they  give  way 
or  burst.  This  plexus  of  convoluted  veins  of  the  chord  is  the 
most  beautiful  in  the  body.  This  convoluted  state  of  the  veins 
is  ever  attendant  on  great  activity  and  exertion  of  the  arteries 
of  the  part.  If  there  is  a provision  in  the  shape,  course,  and 
strength  of  the  arteries,  for  occasional  acceleration  of  the 
blood  through  them  ; so  will  there  be  found  in  the  veins  a tor- 
tuous and  varicose  appearance  ; and  again,  if  by  accident  there 
is  excited  an  uncommon  action  in  the  arteries  of  a living  body, 
that  action  will  be  apparent  from  the  distended  or  enlarged  state 
of  the  veins.  In  the  testicles  of  such  animals  as  have  their 
seasons,  the  artery  and  veins  of  the  testicle  are  still  more  con- 
voluted, and  form  a mass  of  vessels,  which  has  been  called  the 
corpus  pyramidale.* 

The  nerves  of  the  testicle,  like  the  blood-vessels,  come  from 
the  loins,  and  are  continued  down  upon  the  vessels  in  the  sper- 
matic plexus.  This  still  farther  allies  the  testicle  to  the  abdo- 
minal viscera,  giving  them  much  of  the  same  sympathies.  The 
stomach,  intestines,  and  testicle,  sympathise  readily  with  each 
other.  As  we  find  the  tunica  albuginea  of  the  testicle  to  be 
very  firm,  dense,  and  unelastic,  the  great  pain  in  inflammation 
of  the  testicle  has  naturally  been  attributed  to  the  resistance 
made  by  this  coat  to  the  swelling  of  the  substance  of  the  testi- 
cle, but  much  must  be  ascribed  to  the  natural  sensibility  of  the 
part,  independently  of  swelling  and  tension  ; for  in  the  very 
moment  of  a blow,  a person  faints  and  falls  down  from  exqui- 
site pain. 

The  lymphatics  of  the  testicle  are  numerous,  and  easily  de- 
monstrated by  blowing  up  the  cellular  structure  of  the  body  of 
the  testicle  ; and  we  shall  by-and-by  find,  that  this  has  been  the 
ground  of  dispute  between  physiologists  ; and  the  proofs  of 
some  important  points  in  the  doctrine  of  absorption  have  been 
drawn  from  the  injection  of  the  lymphatics  of  the  testicle  and 
chord. 

The  cremaster  muscle,  as  we  have  seen  in  the  first  vo- 
lume, takes  its  origin  from  the  internal  oblique  muscle  of  the 
abdomen,  and,  passing  down  over  the  vessels  of  the  chord,  is  ex- 


* Corpus  varicofum, — Corpus  Pampiniforme ; Galen  de  Semine.  Alias  paraf- 
Jatam  varicofam,  Hall. — As  the  old  phyfiologifts  faw  and  obferved  this  wonderful 
tortuofity,  and  the  tendril-like  form  of  the  fptrmatic  artery,  they  thought  that  as 
there  muft  be  fomething  peculiar  in  this  flrudture,  the  blood  was  here  begun  to  bp 
changed  into  fetnen,  apd  therefore  they  called  them  the  vafa  preparantia. 


OF  THE  TESTES. 


US 


panded  on  the  tunica  vaginalis  : its  use  is  to  suspend  the  testi- 
cle, and  prevent  it  from  dragging  upon  the  vessels  of  the  chord. 

By  constitutional  weakness,  or  the  relaxation  induced  by 
warm  climates,  this  muscle  becomes  relaxed,  and  artificial  sus- 
pension becomes  necessary.  Sometimes  this  muscle  draws  the 
testicle  spasmodically  to  the  groin  ; yet  I cannot  allow  that  this 
is  the  muscle  which  retracts  and  corrugates  the  scrotum,  for 
the  testicle  will  be  thus  drawn  up  by  the  cremaster,  without 
corrugation  or  contraction  of  the  scrotum.  In  some  this  would 
appear  to  be  a voluntary  muscle  ; it  possibly  accelerates  the 
motion  of  the  semen,  or  at  least  promotes  its  secretion. 

Thus  we  find  the  chord  of  the  testicle,  as  it  is  called,  to  con- 
sist of  the  arteries,  veins,  and  nerves  ; of  the  lymphatics  re- 
turning from  the  testicle  ; of  the  cellular  tissue  embracing  and 
supporting  all  these  vessels  ; and  lastly,  of  the  fibres  of  the 
cremaster  muscle. 

OF  THE  STRUCTURE  OF  TtlE  TESTICLE. 

It  is  to  De  Graaff  that  we  owe  the  knowledge  of  the  struc- 
ture of  the  testicle  ; and  indeed  the  merit  of  this  great  anato- 
mist has  not  been  acknowledged  with  sufficient  gratitude  by 
modern  anatomists:  but?  after  the  fervour  of  disputation  has 
subsided,  the  merit  of  ingenuity  and  of  discovery  must  return 
to  him  to  whom  it  is  due.  No  one  more  highly  values  than  I 
do  the  improvements  of  anatomy  by  the  Hunters  and  Monro  : 
but  I must  say,  that  the  structure  of  the  testicle  was  demonstra- 
ted by  De  Graaff  to  his  fellow  anatomists  of  Montpelier,  and 
his  discoveries  published  in  a manner  so  perfect,  as  to  leave  us 
little  to  learn  from  more  modern  authors. 

De  Graaff,  by  exciting  animals  to  venery,  and  tying  the  sper- 
matic chord,  had  the  seminal  vessels  distended.  He  did  not 
depend  upon  injections  ; by  maceration  and  dissection  in  this 
distended  state,  he  unravelled  all  the  intricacies  of  their  tubes. 
More  modern  anatomists  have  proved  the  truth  of  his  observa- 
tions by  injections  of  mercury,  and  have  succeeded  in  a variety 
of  ways  of  preparing  the  testicle. 

Tubuli  testis. — When  the  tunica  albuginea  testis  is  lifted, 
the  body  of  the  testicle  is  found  to  dbnsist  of  innumerable  very 
delicate  white  tubes  ; which,  when  disentangled  from  the  mi- 
nute cellular  membrane  which  connects  them,  and  floated  in 
water,  exhibit  a most  astonishing  extent  of  convoluted  ves- 
sels. By  a closer  attention,  however,  to  this  structure  before 
it  is  thrown  into  confusion  by  pulling  out  the  tubes,  they  appear 
to  be  regularly  laid  in  partitions  of  the  cellular  membrane. 
These  sepimenta  are  very  regular  in  some  animals,  and  while 


320 


OF  THE  TESTES. 


they  separate  the  seminal  tubes,  they  support  and  convey  the 
blood-vessels  to  the  secretion  of  the  semen.  Dr.  Monro  has 
denied  the  formal  divisions  which  De  GraafF  has  engraved, 
but  acknowledges  them  less  regular,  less  easily  found,  and  not 
so  limited  in  their  number  ; nor  does  he  find  them  to  prevent 
all  communication  betwixt  the  tubes  ot  the  testicle. 

These  seminiferous  tubes  of  Haller,  or  tubuli  testis  of 
Monro,  running  in  meshes,  15  or  20  in  number,  terminate  on 
the  back  of  the  testicle.  Each  of  these  tubes  seems  to  be 
cylindrical,  or  of  one  diameter  throughout  their  whole  extent  : 
we  see  no  communication  betwixt  them  ; no  branches  given 
out  or  going  into  them  ; no  beginning  for  the  whole,  nor  for 
any  on-e  of  them.  Though  we  cannot  prove  it,  yet  there 
seems  to  be  only  one  tube  wonderfully  convoluted  and  folded 
up  in  each  subdivision  of  the  testicle. 

Rete  testis. — When  the  tubuli  come  out  from  the  body  of 
the  testicle,  they  run  along  the  back  of  it,  and  communicate 
by  inosculations  with  each  other,  so  as  to  form  a net-work  of 
vessels,  from  which  appearance  Haller  named  them  rete  testis. 

Here  it  often  happens  that  the  mercury  stops,  when  it  has 
been  injected  backward  from  the  vas  deferens  ; and  it  is  this 
part  which  has  been  better  described  and  drawn,  in  conse- 
quence of  mercurial  injections,  than  jt  was  by  De  GraafF ; for 
he,  as  we  have  said,  saw  this  part  only  filled  with  semen. 

Connected  with  the  rete  testis  is  the  corpus  highmorian- 
um. — Where  the  lines  of  the  membranous  septa,  and  cellular 
membrane  of  the  testicle,  meet  on  the  back  of  the  testicle, 
and  under  the  epidimis,  they  form  a white  line.  This  white 
line  running  along  the  testicle,  was  supposed  by  Highmore  to 
be  a hollow  tube  ; it  was  compared  with  the  salivary  duct  ; it 
was  thought  to  be  a cavity  leading  from  the  body  of  the  testicle 
to  the  head  of  the  epididimis,  and  to  form  the  communication 
by  which  the  semen  flowed  from  the  testicle.  De  GraafF  first 
refuted  this  notion,  and  shewed  that  it  was  not  by  this  one 
great  duct,  but  by  these  smaller  tubes  forming  ^vhat  has  been 
now  called  the  rete  testis,  that  the  semen  came  from  the  testi- 
cle : still  it  had  continued  a question,  whether  this  white  line 
was  really  solid,  or  a tube  ; and  upon  faithful  examination  of 
the  point  it  appears,  that$his  is  expressly  as  it  was  explained 
bv  De  GraafF,  viz.  that  it  is  a mere  collection  of  the  mem- 
branes of  the  body  of  the  testicle,  forming  a linen  alba  ; and 
as  the  septa  are  more  distinguishable  in  some  animals,  so  is  the 
corpus  highmorianum.^' 


* This  body  called  a mere  frmanienium  or  binding,  Winflow;  the  nucleus  teftis- 


OB  THE  TESTES, 


121 


Vasa  efferentia. — The  tubes  running  on  the  back  of  the 
testicle,  and  forming  the  rete  testis,  we  have  understood  to 
arise  from  the  tubuli  testis  ; now  it  is  the  continuation  of  the 
rete  testis  which  is  called  vasa  efferentia.  The  Vasa  efferentia 
are  very  delicate  vessels  which  run  out  from  the  head  of  the 
testicle,  single  at  first,  but  they  are  soon  convoluted,  and  by 
these  convolutions  they  are  formed  into  an  equal  number  of 
vascular  cones,  which  constitute  the  head  or  larger  part  of  the 
epididimis.  These  vasa  efferentia  and  vascular  cones  are  con- 
nected by  a very  delicate  cellular  membrane  ; and  it  is  a piece 
of  very  nice  dissection  to  display  them  after  they  are  injected 
with  mercury. 

Epididimis. — The  vasa  efferentia,  after  forming  thin  coni- 
cal convolutions,  unite  and  form  larger  tubes  ; these  again 
uniting,  form  one  large  excretory  duct,  the  vas  deferens  : but 
this  vessel  being  convoluted  to  a wonderful  degree,  forms  a 
body,  which  being,  as  it  were,  placed  upon  the  testicle,  has 
been  called  epididimis. 

Seventh  Ulan  of  the  Testicle. 


7th  Plan  of  theTeftide. 


In  this  representation  of  the  dissected  testicle,  A is  the  body 
of  the  testicle  divested  of  its  coats  ; B,  the  tubuli  testis 
CC,  the  rete  testis  ; D,  the  vasa  efferentia  ; E,  the  vascular 
cones ; F,  the  epididimis  formed  of  the  convolutions  of  the 
vas  deferens  ; lastly,  G is  the  vas  deferens. 

In  the  substance  of  the  testicle  there  are  no  glands  nor 

* Where  the  tubuli  are  emerging  to  form  the  rete  vafculofum,  they  are  called 
the  vafa  refta. 

Vol.  IV.  Q 


122 


OF  THE  TESTES. 


follicules ; the  arteries  minutely  ramify  amongst  the  seminal 
tubes,  and,  there  is  reason  to  believe,  secrete  the  semen  into 
them.  The  seminal  vessels  in  the  substance  of  the  testicle,  or 
tubuli  testis,  run  together  upon  the  surface  of  the  testicle,  and 
form  the  rete  testis.  From  the  rete  testis  are  continued  the 
vascular  cones : these  convolute,  and  running  together  form 
the  epididimis  ; from  which  the  tube  is  continued  under  the 
name  of  the  vas  deferens.  It  passes  up  the  chord  ; enters  by 
the  ring  into  the  abdomen  ; and  then  passing  down  into  the 
pelvis,  terminates  in  the  vesiculse  seminales,  in  a manner 
presently  to  be  explained.  It  is  not  likely  that  the  vis  a tergo, 
the  power  of  the  arteries,  pushes  the  semen  through  all  this 
length  of  tube,  of  which  the  epididimis  itself  is  reckoned  to 
be  several  feet  in  length,  if  the  various  convolutions  were  un- 
done. Such  an  action  on  the  testicle  as  that  of  the  dartos  or 
cremaster  muscle,  could  give  only  a general  stimulus,  but 
could  not  force  on  the  semen  in  tubes  which  take  so  great  a 
variety  of  directions.  We  are  therefore  left  to  the  supposition, 
that  these  tubes  themselves  have  a power  of  accelerating  the 
fluids  through  them.  # 

Of  the  lymphatics  of  the  testicle  we  shall  afterwards  treat ; 
it  is,  however,  necessary  here  to  remark,  that  Prochaska 
found  in  his  injections  a difficulty  in  making  the  mercury  pass 
the  rete  testis  into  the  testicle.  Observing  at  the  same  time  in 
his  preparations,  and  in  the  drawings  of  all  authors,  an  ap- 
pearance of  irregularities  in  this  part  like  the  valvular  structure 
of  lymphatics,  he  has  been  led  to  suppose  that  there  is  a pro- 
vision here  for  preventing  the  semen  from  being  forced  back- 
ward into  the  testicle  by  the  action  of  the  cremaster  muscle  ; 
he  conceives  that  when  the  cremaster  muscle  draws  up  the 
testicle  to  the  groin,  it  may  accelerate  the  semen  in  the  epidi- 
dimis, whilst  this  valvular  structure  prevents  the  regurgitation 
upon  the  delicate  vessels  of  the  substance  of  the  testicle. 

The  annexed  plate  represents  the  appearance  which  I have 
found  in  my  preparations.  A,  the  vas  deferens  by  which  the 
mercury  was  injected  ; B,  the  epididimis  ; C,  vessels  running 
up  the  chord  from  the  great  head  of  the  epididimis. 

There  is  a duct  which  sometimes  arises  from  the  epididimis, 
and  which  has  been  found  to  terminate  abruptly  in  a blind 
end — of  this,  Mr.  Hunter  speaks  in  the  annexed  note.* 

* “ By  a fupernumerary  vas  deferens,  I mean  a fmall  duct,  which  fometimes 
arifes  from  the  epididimis,  and  paffes  up  the  fpermatic  chord  along  with  the  vas 
deferens,  and  commonly  terminates  in  a blind  end,  near  to  which  it  is  fometimes 
a little  enlarged.  I never  found  this  dudt  go  on  to  the  urethra,  but  in  fome  in- 
flances,  have  feen  it  accompany  the  vas  deferens  as  far  as  the  brim  of  the  pelvis. 
There  is  no  abfolute  proof  that  it  is  a fupernumerary  vas  deferens ; but  as  we  find 


OF  the  TESTES. 


123 


OF  THE  TESTICLE  IN  GENERAL. 

The  testicle  is  of  an  oval  form,  and  of  the  size  of  a pigeon’s 
egg  : it  is  a little  flattened  on  the  sides  : it  hangs  in  the  scrotum 
by  the  spermatic  chord  ; one  end  of  the  oval,  forward  and 
high  ; see  plan  8th  B ; while  the  other  is  backwards,  and 
drops  lower,  C.  The  spermatic  chord  consists  of  the  artery 
which  brings  blood  ; of  the  veins  which  return  it  ; of  the  vas 
deferens,  which  carries  the  semen  to  the  vesicuke  seminales 
at  the  neck  of  the  bladder;  of  lymphatics,  which  are  essential 
to  the  structure  of  every  part.  This  chord  of  vessels  comes 
down  from  the  belly,  and  passes  by  the  ring  of  the  abdominal 
muscle  ; it  is  about  four  inches  in  length,  and  is  fixed  into  the 
upper  and  fore  part  of  the  body  of  the  testicle. 

The  body  of  the  testicle  is  easily  distinguished,  and  is  the 
place  where  the  secretion  is  performed.  It  is  strictly  the  body 
of  the  gland,  while  the  part  above  it  is  only  the  duct  by  which 
its  fluid  is  discharged. 

The  ancients  called  the  testicle  dydimi,  gemini,  twins  ; 
they,  therefore,  called  that  part  which  is  laid  on  the  back  of 
the  testicle  epididimis,  as  added  to  it.  To  the  surgeon,  it  is 
essentially  necessary  to  attend  to  the  relation  of  the  parts  of 
the  testicle  as  felt  through  the  scrotum. 


Eighth  Plan  of  the  Testicle . 

8th  Plan  of  the  Tefticle. 


the  dudls  of  glands  in  general  very  fubjedl  to  Angularities,  and  that  there  are  fre- 
quently lupernumerary  dudls,  there  being  often  two  ureters  to  one  kidney,  fome- 
times  diftindt  from  beginning  to  end,  at  other  times  both  arifing  from  one  pelvis  ; 


m 


®F  THE  TESTES. 


In  this  8th  plan,  fig.  1.  we  see  the  testicle  as  in  its  natural 
situation,  covered  with  its  membranes,  and  appearing  like  one 
body  ; while,  in  the  second  figure,  it  being  represented  freed 
from  its  outer  coat,  we  see  the  epididimis  as  laid  upon  the  testi- 
cle, and  consisting  of  the  convoluted  tube.  First,  we  observe 
A,  the  body  of  the  testicle  ; B,  the  beginning  of  the  epididi- 
mis, or  the  large  head  of  the  epididimis.*  Then  we  see  it 
laid  .dong  the  back  of  the  testicle,  and  observe  C to  be  the 
small  head  of  the  epididimis, f where  the  tube  is  reflected  to 
reascend  upon  the  testicle,  and  to  form  D,  the  vas  deferens. 

Now,  we  have  to  observe,  that  the  point  C,  fig.  2.  or  small 
head  of  the  epididimis,  hangs  over  the  testicle,  and  points 
backwards  to  the  perineum,  and  can  be  felt  through  the  whole 
coats  ; and  that  the  body  of  the  testicle  A,  is  towards  us  when 
we  examine  a patient — Further,  as  the  letters  in  figure  1 and 
2.  refer  to  the  same  points,  we  have  only  to  notice  the  fainter 
indication  of  the  parts  in  fig.  1.  it  being  invested  with  the  coats  ; 
and  to  observe  the  general  relation  of  the  testicle  to  the  scro- 
tum and  penis. 

There  is  one  other  circumstance  to  be  observed,  viz.  that 
the  epididimis  is  always  laid  on  the  outer  side  of  the  insertion 
of  the  chord  into  the  testicle  ; from  which  we  distinguish, 
with  ease,  in  a preparation,  to  which  side  the  testicle  belongs. 
Thus,  in  the  annexed  plans,  the  testicle  of  the  left  side  is 
represented,  w’hich  we  know  from  the  points  c,  being  directed 
backward,  while  the  epididimis  is  laid  along  the  left  side  of  the 
insertion  of  the  chord. 

or  THE  VESICULiE  SEMIFALES. 

Behind  the  prostate  gland,  and  attached  to  the  lowest  part 
of  the  urinary  bladder,  lie  two  soft  bodies,  which  are  the  vesi- 
euke  sem inales.  They  appear  like  simple  bags  when  seen 

from  without,  but  dissections  show  them  to  consist  of  a cellu- 
lar structure  ; each  oi  these  bodits  is  about  three  fingers- 

thefe  dufts,  arifing  from  the  epididimis,  I am  inclined  to  believe  from  analogy, 
are  of  a nature  fimilar  to  the  double  ureters.  They  refemble  the  vas  deferens,  as 
being  continuations  of  fome  of  the  tubes  of  the  epididimis,  are  convoluted  where 
they  come  off  from  it,  and  afterwards  become  a flraight  canal  paffing  along  with 
it  for  feme  way,  when  they  are  commonly  obliterated. 

“ The  idea  of  their  being  for  the  purpofe  of  returning  the  fuperfluous  femcn  to 
the  circulation  is  certainly  erroneous,  from  their  being  fo  feldom  met  with,  and  fo 
very  feldom  continued  further  than  the, brim  of  the  pelvis.” 

* Globus  major,  or  head. 

f Globas  minor  canda.  This  part  we  often  diflinguifh  retaining  its  hardnef? 
after  the  fubfiding  of  the  general  fwelling  of  hernia  fcmoralis.  From  this  poinr 
we  can  trace  all  the  connections  of  the  other  parts. 


oe  the  Testes'. 


125 


breadth  in  length  ; their  backmost  point  is  large  and  round, 
and,  at  the  same  time,  that  they  diverge  from  each  other,  their 
narrow  points  unite,  or  are  contiguous  to  each  other  forwards, 
and  enter  at  the  back  part  of  the  base  of  the  prostate  gland. 

As  we  have  seen,  the  peritoneum  does  not  descend  far 
enough  betwixt  the  bladder  and  rectum  to  cover  or  invest  these 
vesicula-  ; they  are  therefore  involved  in  the  cellular  texture, 
and  covered  with  strong  fibres,  besides  being  subject  to  the 
compression  of  the  levator  ani  muscle.  When  the  vesiculse 
are  cut  into,  and  especially  when  they  are  distended,  dried, 
and  cut,  they  present  a cellular  appearance  ; but  if  they  are 
carefully  dissected,  they  present  the  appearance  of  a small 
blind  intestine  convoluted. 

This  cellular  appearance  is  given  by  the  duplication  of  their 
inner  membrane,  together  with  the  distortions  and  curves  of 
the  canal.  Their  outer  surface  is  covered  with  a fine  mem- 
brane, which,  like  a frenum,  connects  these  cellular  convo- 
lutions. 

These  are  copiously  supplied  with  arteries  ; their  surface  is 
covered  with  veins  and  lymphatics  when  these  vessels  are 
minutelv  injected,  and  their  coat  is  thick  and  spongy.  Heister, 
Winslow,  and  others,  have  described  small  glands  as  seated 
in  their  sinuosities  ; but  these  are  confidently  denied,  and  in 
their  place  there  is  described  a pile  or  efflorescence.  There 
can  be  little  hesitation  in  affirming,  that  these  vesiculse  are 
themselves  glands,  or,  in  other  words,  that  the  arteries  secrete 
into  them  a peculiar  fluid.  The  fore  part  of  each  of  the 
vesiculse,  which  we  have  said  sink  into  the  back  part  of  the 
prostate  gland,  runs  under  the  neck  of  the  bladder,  and  opens 
by  distinct  mouths  into  the  urethra,  on  the  surface  of  the 
verumontanum. 

The  connection  of  the  vas  deferens  with  the  vesiculse,  is 
very  particular,  it  does  not  open  directly  into  them,  but  opens 
with  them  into  the  urethra  in  such  a way,  that  the  semen  from 
the  testicle  can  pass  into  the  vesiculse,  though  its  direct  course 
is  into  the  urethra.^ 

If  air  is  blown  into  the  vas  deferens,  the  vesiculse  will  be 
distended  at  the  same  time  that  the  air  passes  into  the  urethra  : 
the  union  of  the  extremities  of  the  vas  deferens  and  vesiculse, 
forms  a kind  of  septum  betwixt  them. 

The  extremity  of  the  vas  deferens  join^  the  duct  of  the 
vesiculse  where  it  is  imbedded  in  the  prostate  gland  ; the  union 
of  the  vas  deferens  and  duct  of  the  vesiculse  is  not  attended 
with  an  enlargement  of  the  duct ; on  the  contrary,  as  the  duct 


Sec  explanation  of  plate  TI-I. 


126 


OF  THE  TESTES. 


passes  forward  deep  into  the  substance  of  the  gland  to  arrive 
at  the  urethra,  it  becomes  remarkably  narrower  until  it  opens 
in  a very  small  orifice  in  the  verumontanum,  as  we  see  repre- 
sented in  the  third  plate.  The  duct  (if  we  may  so  call  it,)  of 
the  vesiculae  passes  a full  inch  forward  into  the  gland  before  it 
terminates  in  the  urethra. 

These  vesiculae  have  been  in  general  supposed  to  be  recepta- 
cles for  the  semen  ; but  as  this  is  an  opinion  depending  on  the 
connection  of  these  bags  with  the  extremities  of  the  vas  de- 
ferens, and  as  comparative  anatomy  shows  many  instances  of 
these  vesiculae  being  unconnected  with  the  ducts  of  the  testicle, 
there  is  much  reason  to  doubt  whether  they  really  are  merely 
reservoirs.  They  have  always  appeared  to  me  as  useful  in 
adding  a fluid  to  the  secretion  of  the  testicle,  which  being 
poured  together  into  the  sinus  of  the  urethra,  give  a disten- 
tion, exciting  and  giving  effect  to  the  contraction  of  the  ejacu- 
lator  seminis  : For  unless  there  were  a provision  of  fluid  suf- 
ficient to  distend  the  sinus  of  the  urethrae,  the  semen  could  not 
be  thrown  out  from  the  urethra.  This  supposition  is  not  op- 
posed by  the  facts  stated  by  Mr.  Hunter,  that  in  many  animals 
the  vesiculae  and  vasa  deferentia  open  by  distinct  foramina  into 
the  urethra,  because  in  that  case  the  fluids  of  these  secreting 
bags  might  be  equally  mingled  with  the  semen  in  the  sinus  of 
the  urethra,  although  they  do  not  flow  from  the  same  tube. 

Verumontanum.— -The  verumontanum,  or  caput  galina- 
ginis,  is  an  eminence  on  the  lower  part  of  the  urethra,  where 
it  is  surrounded  by  the  prostate  gland.  As  we  observe  in  the 
drawing,  it  is  larger  and  round  towards  the  bladder,  and 
stretches  with  a narrow  neck  forwards.  On  its  summit,  the 
two  orifices  of  the  seminal  vessels  open  ; and  around  it  there 
are  innumerable  lesser  foramina  and  mucous  follicules. 


PART  THE  THIRD. 


OF  THE  FEMALE  PARTS  OF  GENERATION. 


THE  ANATOMY  OF  THE  PARTS  IN  THE  FE- 
MALE PELVIS. 


There  is  considerable  difficulty  in  presenting  such  a view 
of  the  anatomy  of  the  parts  of  generation  in  woman,  as  may 
bear  a due  relation  to  this  general  system  of  anatomy,  and,  at 
the  same  time,  be  intelligible  and  complete.  The  subject  is  in 
itself  extensive  and  important,  sufficient  to  fill  several  volumes : 
it  is  much  connected  with  practice  ; and  the  phenomena  and 
diseases  of  the  system  serve  greatly  to  illustrate  the  strict  ana- 
tomy of  the  parts.  I cannot  here  be  allowed  to  give  to  it  its 
due  importance,  whilst  yet  it  is  a subject  not  easily  understood 
from  a short  abstract. 

The  parts  of  generation  are  divided  into  the  external,  which 
are  those  without  the  pelvis  ; and  the  internal,  or  viscera  of  the 
pelvis,  and  which  lie  within  the  bony  circle  of  the  pelvis. 


( 128  ) 


CHAP.  I. 


THE  EXTERNAL  PARTS  OF  GENERATION. 

T-1  HE  external  parts  of  generation  are  the  mons  veneris,  labiae, 
clitoris,  nymphae,  urethra,  hymen,  or  carunculte  myrtiformes. 
Upon  these  subjects  we  have  no  want  of  books  and  informa- 
tion ; for  accoucheurs  of  the  old  school  dwelt  upon  the  descrip- 
tion with  particular  accuracy.  These  parts  were  within  their 
ken,  which  we  cannot  say  of  the  viscera  of  the  pelvis  : and, 
therefore  upon  the  former  we  shall  be  more  brief. 

In  very  young  children  these  external  parts  bear  a large  pro- 
portion to  the  body,  greater  than  at  any  subsequent  period  be- 
fore the  age  of  puberty.  At  puberty  they  are  suddenly  and 
completely  evolved,  and  acquire  an  increase  of  size  ; while, 
from  the  age  of  two  years  to  twelve  or  thirteen,  there  has 
been  little  increase.  Immediately  before  menstruation,  com- 
mences the  connection  which  occasions,  or  accompanies  that 
flux.  It  begins  to  effect  the  evolution  of  the  uterine  system, 
and  to  fit  it  for  its  peculiar  function.  The  parts  become  turgid 
and  vascular  ; the  fat  is  deposited  in  the  surrounding  cellular 
membrane.  About  the  fortieth  year,  when  the  menses  disap- 
pear, this  fulness  of  the  private  parts  also  ceases,  and  the  fat 
is  reabsorbed. 

The  mons  veneris  is  that  prominence  on  the  symphysis 
pubis,  which  consists  of  the  skin  raised  and  cushioned  up  by 
the  fat  inclosed  in  the  cellular  membrane.  There  is  of  course 
a great  variety  in  its  size.  In  early  life  it  is  small : it  be- 
comes, as  we  have  said,  more  prominent  at  the  age  of  puberty  ; 
in  fat  women  it  is  of  an  enormous  size  ; and  in  some  warm 
climates  a particular  laxity  prevails.  From  the  hair  on  this 
part,  marking  the  age  of  puberty,  it  is  called  pubis.  As  the 
lax  texture  admits  of  distention  with  the  fluid  of  anasarca,  it 
is  sometimes  from  this  cause  very  greatly  swelled. 

The  labile.  These  are  often  named  alse,  from  a slight 
resemblance  to  wings,  and  they  are  also  called  externse,  mag- 
nse,  or  majores,  from  their  place,  and  from  their  superiority 
in  respect  of  size  over  the  nymphse.  The  labiae  seem  to  be  the 
mons  veneris  continued  downward,  and  laterally  until  meeting 
below,  they  form  the  vulva  ; at  their  lower  angle,  by  their 
union,  they  form  the  fourchette,  or  frenum  labiorum.  The 
structure  of  the  labise  is  similar  to  that  of  the  mons  veneris  ; 
sometimes  one  is  larger  than  the  other. 


THE  EXTERNAL  PARTS  OF  GENERATION.  129 

The  great  sensibility  of  the  membrane  which  lines  the  inside 
of  the  labis,  requires  some  defence,  and  therefore  the  whole 
surface  is  amply  supplied  with  mucous  follicules  and  glands. 
The  labiae  are  a protection  to  the  other  soft  parts,  so  necessary, 
that  the  clitoris,  or  nymphse,  when  they  project  beyond  them, 
are  subject  to  violent  inflammation. 

The  parts  here  have  either  such  folds,  or  are  of  so  lax  a 
texture,  as  to  permit  a great  degree  of  distention  during  the 
passage  of*  the  child.  But,  as  the  labiae  have  no  muscular 
power,  and  depend  entirely  on  their  elasticity  for  restoring 
them  to  their  original  size,  they  commonly,  after  being  very 
much  dilated,  remain  in  some  degree  larger  and  more  lax.  It 
is  different  with  muscular  p irts,  as  the  orificium  externum, 
which,  by  the  power  of  its  sphincter,  is  restored  after  labour 
to  its  original  size.  In  man,  hernia  descends  from  the  abdo- 
minal ring  into  the  scrotum  ; but,  in  woman,  when  there  is  a 
rupture  from  the  ring,  (which  is  rare)  it  may  fall  into  the  labiae, 
though,  I believe,  it  will  be  seldom  found  to  descend  thus  far. 

The  nymphA  named  labiae  vel  alse  minores,  or  labiae  in- 
temae,  to  distinguish  them  from  the  great  labiae.  They  are 
like  a miniature  representation  of  the  great  labiae  ; they  are 
covered  with  a very  delicate  membrane,  and  have  great  sensi- 
bility. They  begin  immediately  under  the  glans  clitoridis, 
and  seem  to  be  only  an  extension  of  its  preputium,  formed  by 
a folding  of  the  membrane.  Their  size  varies  much.  They 
commonly  stretch  downward,  and  backward  to  the  middle  of 
the  orifice  of  the  vagina  ; sometimes  no  further  than  to  that  of 
the  orificium  urethrae,  and  in  a few  instances  they  extend  even 
the  length  of  the  fourchette.^  They  are  very  vascular,  and 
have  somewhat  of  a cellular  structure,  and  thus  partake  of  a 
degree  of  turgidity,  in  consequence  of  irritation  and  vascular 
action.  The  most  modest  of  the  uses  ascribed  to  them  is, 
that  of  directing  the  stream  of  urine.  As  they  are  obliterated 
during  the  passage  of  the  child’s  head  through  the  vulva,  it  is 
probable  that  they  facilitate  the  necessary  dilatation. 

The  nymphte  are,  in  their  natural  situation,  covered  and 
completely  protected  by  the  labiae  externce.  When  naturally 
large  or  increased  by  disease,  or  in  a very  relaxed  state,  they 
are  deprived  of  this  covering  : they  project  from  under  the 
labiae,  and  are  apt  to  become  inflamed,  and  even  to  ulcerate. 
The  original  disease,  or  tumour,  is  augmented,  or  they  be- 
come perhaps  hard  and  callous.  In  children  the)’  bear  a very 
great  proportion  to  the  other  parts,  and  are  more  conspicuous 


* Both  Riolin  and  Morgagni  have  ohferved  the  part;  wich®Ht  the  nvmnh'z- 

Vol.  IV.  R 


130 


THE  EXTERNAL  PARTS  O?  GENERATION. 


and  prominent  than  in  the  adult.  Their  diseased  enlargement 
sometimes  requires  to  be  extirpated,  in  which  operation,  as 
they  are  very  vascular,  and  as  with  their  growth,  their  blood- 
vessels enlarge,  considerable  hsemorrhagy  may  be  expected. 
A surgeon  of  this  city,  in  extirpating  a tumour  of  this  kind 
from  a young  lady,  thought  his  duty  fulfilled  when  he  had  ap- 
plied a piece  of  lint  upon  the  surface  after  the  operation,  so 
that  he  even  neglected  to  appoint  an  attendant.  The  haemorr- 
hagy  returned,  and  continued  so  profuse  that  before  the  sur- 
geon arrived  the  lady  had  fainted. 

The  clitoris  is  similar  to  the  male  penis.  Like  the  penis,, 
it  consists  of  cells  for  receiving  blood,  and  in  a similar  manner, 
it  arises  from,  or  takes  hold  of  the  rami  of  the  os  pubis  by  two 
crura  ; — these  unite  at  the  symphysis  pubis,  to  form  the  body 
of  the  clitoris,  which  is  suspended  from  the  os  pubis,  like  the 
penis,  by  a kind  of  ligament.  The  clitoris  has  also  a kind  of 
glans,  over  which  the  integuments  make  a fold  like  a preputi- 
um.  In  short,  it  has  the  same  sensibilities,  the  same  power  of 
erection  with  the  membrum  virile  ; only  it  has  no  urethra  nor 
spongy  body,  like  that  of  the  urethra  of  man. 

The  stories  of  the  increase  of  this  instrument,  even  to  its 
pre-eminence  in  size  over  the  male  penis,  are  very  idle,  but 
there  seems  to  be  a peculiar  predilection  for  them.  It  is  not 
wonderful  that  a clitoris  of  such  magnitude  should  suggest  the 
idea  of  a hermaphrodite,  or  person  partaking  equally  of  the 
distinguishing  attributes  of  either  sex. 

OP  THE  URETHRA. 

The  urethra  of  the  female  is  short,  straight,  and  wide  ; its 
length  an  inch  and  a half,  or  two  inches  ; its  direction  nearly 
straight,  or  only  slightly  bending  under  the  os  pubis  ; and  its 
diameter  such  as  will  admit  a catheter  the  size  of  a writing- 
quill.  The  consequences  of  these  peculiarities  are,  that  the 
catheter  is  easily  passed  when  there  is  no  very  unusual  obstruc- 
tion ; that  women  are  not  so  much  exposed  to  the  disease  of 
stone  in  the  bladder  as  men,  for  though  this  is  much  owing  to 
constitutional  peculiarities,  yet  it  is  obvious,  that  when  a small 
stone  is  formed,  and  passes  from  the  bladder,  it  is  easily  dis- 
charged ; and,  lastly,  that  lithotomy  is  a very  simple  operation 
in  woman. 

The  opening  of  the  urethra  is  in  a direct  line  under,  or  be- 
hind the  clitoris,  and  about  an  inch  from  it  : It  is  in  the  middle 
of  a slight  prominence,  and  its  vicinity  is  plentifully  supplied 
with  mucous  glands.  If  the  relation  of  the  orifice  to  the 
clitoris  be  observed,  there  is,  in  the  natural  state  of  the  parts. 


THE  EXTERNAL  PARTS  OF  GENERATION. 


131 


no  difficulty  in  slipping  the  point  of  the  catheter,  on  the  end  of 
the  middle  finger,  from  the  clitoris,  until  it  is  catched,  upon 
the  lacuna-like  orifice  of  the  urethra  ; but  even  in  this  part  of 
the  operation,  I have  experienced  great  embarrassment,  from 
an  irregular  ulcerated  or  cancerous  surface  of  the  parts,  by 
which  all  the  usual  distinctions  were  lost. 

From  the  length  and  sudden  turns  of  the  male  urethra, 
from  the  double  function  it  performs,  and  from  its  being  em- 
braced by  the  prostate  gland,  the  obstructions  of  the  urine  are 
more  frequent,  and  the  catheter  less  easily  passed,  than  in 
woman.  The  catheter  too  requires  to  be  of  a very  peculiar 
form.  The  short  and  wide  urethra  of  woman  requires  only  a 
simple  and  almost  straight  tube  : and  although,  accurately  to 
adapt  it  to  the  course  of  the  urethra,  a considerable  curve 
might  be  given  to  it,  yet  that  is  not  necessary  in  common  cases  ; 
and  circumstances  will  occur  to  the  accoucheur  which  will  pre- 
clude the  possibility  of  using  such  an  instrument. 

We  shall  only  mention  here  such  cases  of  obstruction  of 
urine  as  are  in  a particular  manner  illustrated  by  the  anatomy 
and  connection  of  the  parts.  These  are  tumours  of  the  ovari- 
um, tumours  of  the  womb,  polypi,  distention  of  the  vagina, 
displacement  of  the  womb,  as  procidentia,  prolapsus,  retro- 
versio,  &c.  ; and  lastly,  the  child’s  head  in  labour. 

The  ovarium  being  enlarged,  and  falling  down  into  the 
pelvis,  either  presses  upon  the  neck  of  the  bladder,  causing 
obstructions,  or  pressing  and  weighing  on  the  fundus  of  the 
bladder,  it  occasions  a stillicidium  urinse. 

Tumours  of  the  womb,  especially  of  the  neck  or  orifice,  as 
it  is  in  contact  with  the  urethra,  very  soon  affect  this  organ. 
Thus,  I have  seen  a cancer  of  the  orifice  of  the  womb,  by  ex- 
citing inflammation  in  all  the  surrounding  parts,  and  by  mas- 
sing them  together  into  a tumour  filling  the  pelvis,  occasion  ob- 
stinate obstruction  of  urine. 

Polypi  attached  to  the  orifice  of  the  womb,  and  filling  the 
vagina,  produce  the  same  effect.  In  all  such  cases,  perhaps, 
the  tumour  may  be  pushed  up,  so  as  to  permit  the  flow  of  urine,- 
or  the  introduction  of  the  catheter. 

A case  occurred  to  Mr.  John  Bell,  in  which  the  tumour  of 
-the  womb  compressed  the  neck  of  the  bladder.  A catheter 
was  passed,  and  gave  instant  relief.  The  midwife,  after 
some  time  came,  and  said,  that  the  catheter  would  not  pass. 
He  found  that  he  could  pass  tire  catheter  into  the  bladder,  but 
no  urine  flowed  ; and  it  was  discovered,  that  the  tumour  in- 
creasing backtvard,  came  to  press  upon  the  ureters,  so  as  com- 
pletely to  obstruct  them  where  they  enter  the  bladder.  Th? 


132 


THE  EXTERNAL  PARTS  ©F  GENERATION. 


woman  unavoidably  died  ; each  kidney  and  ureter  was  founci 
to  contain  four  or  five  ounces  of  urine. 

A slight  sketch  of  the  parts  in  the  female  pelvis  will,  per- 
haps, better  explain  the  connections  of  the  neck  of  the  bladder 
than  any  description,  and  will  certainly  better  illustrate  the 
cause  of  some  kinds  of  obstruction,  particularly  that  arising 
from  the  change  in  the  posture  of  the  womb. 

First  Plan  of  the  Female  Pelvis. 


A,  the  os  pubis  cut  through. — B,  the  spine  and  sacrum  also 
eut  directly  down. — C,  the  urinary  bladder  moderately  disten- 
ded, and  rising  behind  the  pubis. — D,  the  urethra,  very  short, 
and  taking  a gentle  curve  under  the  symphysis  of  the  os  pu- 
bis.— E,  the  fundus  of  the  womb. — F,  the  os  tines,  or  orifice 
of  the  womb. — G,  the  vagina H,  the  rectum. 

Prolapsus,  or  falling  down  of  the  womb,  is  frequent  with 
those  who  have  born  many  children.  By  this  slipping  down 
of  the  body  of  the  womb  F,  into  the  vagina  G,  it  presses  on  the 
neck  of  the  bladder,  or  urethra.  This  is  also  apt  to  happen  in 
the  first  months  of  pregnancy,  from  a degree  of  difficulty  which 
the  womb  in  its  enlargement  has  in  rising  above  the  brim  of  the 
pelvis. 

We  may  observe  also  from  the  place  of  the  vagina  G,  that 
its  diseases,  its  scirrhous  hardening,  its  distention  by  the  men- 
ses, will  also  compress  the  urethra  and  neck  of  the  bladder. 

The  retroversion  of  the  womb  is  the  most  formidable  obstruc- 
tion to  the  urethra.  It  is  produced  by  distention  of  the  blad- 
der acting  on  the  womb  in  a particular  situation,  and  is  the 
cause  of  suppression  of  the  urine.  When  the  womb  in  the 


THE  EXTERNAL  PARTS  OE  GENERATION. 


133 


third  or  fourth  month  of  gestation  has  increased  so  much  as 
to  produce  a degree  of  compression  on  the  surrounding  parts, 
and  to  rise  above  the  brim,  and  shoot  up  into  the  abdomen,  a 
distention  of  the  bladder  is  apt  to  throw  the  fundus  under  the 
projection  of  the  sacrum.  We  have  to  observe  the  connection 
betwixt  the  back  and  lower  part  of  the  vagina.  By  the  disten- 
tion of  the  bladder,  the  vagina  is  stretched,  and  the  orifice  of 
the  womb  is  raised,  which  throws  back  the  fundus  of  the 
womb,  so  that  this  comes  to  be  the  situation  of  the  parts. 

Second  Plan  of  the  Female  Pelvis . 


A,  the  os  pubis;  B,  the  sacrum  ; C,  the  bladder  of  urine 
much  distended,  and  rising  above  the  pubis  ; D,  the  connection 
betwixt  the  back  part  of  the  bladder  and  the  upper  part  of  the 
vagina,  and  through  which  the  rising  of  this  part  of  the  blad- 
der (in  consequence  of  its  distention)  has  drawn  up  the  orifice 
of  the  womb,  and  thrown  back  the  fundus.  E,  the  orifice  of 
the  womb,  which  being  raised  and  turned  up,  no  longer  pre- 
sents so  as  to  be  felt  by  the  finger  in  the  vagina.  It  will  be  ob- 
served also,  that  the  womb  now  lying  across  the  pelvis,  this 
lower  part  is  forced  against  the  neck  of  the  urethra,  so  as  to 
compress  it,  and  cause  total  obstruction  of  urine.  F,  the  va- 


184 


THE  EXTERNAL  PARTS  OF  GENERATION. 


gina,  which  is  stretched  in  consequence  of  the  rising  and  turn- 
ing up  of  the  orifice  of  the  womb.  G,  the  fundus  of  the 
womb  enlarged  and  distended  by  impregnation,  fallen  back 
under  the  promontory  of  the  sacrum,  and  compressing  the  rec- 
tum H. 

Now,  when  the  fundus  of  the  womb  is  thrust  back,  and  the 
orifice  raised  bv  the  distention  and  consequent  rising  of  the 
bladder,  the  natural  and  simple  cure  is  to  introduce  the  cathe- 
ter, and  draw  ofT  the  urine.  But  should  this  not  be  done  at 
first,  then  there  being  distention  of  the  bladder,  and  pressure 
on  the  rectum,  the  abdominal  muscles  sympathize  with  these 
parts,  so  that  bearing-down  efforts  are  made,  and  the  fundus  of 
the  womb  is  forced  further  down  into  the  hollow  of  the  sacrum, 
while  the  orifice  is  directed  upward. 

Were  this  distention  to  happen  at  any  other  time  than  just 
when  the  uterus  is  of  such  a size,  that  being  thrown  back,  it 
catches  under  the  sacrum,  and  does  not  rise  again,  no  harm 
could  follow. — I last  year  attended,  with  Mr.  Cheyne  senior, 
a woman  afflicted  with  obstruction  of  urine,  who  died.  I after- 
wards opened  the  body,  where  the  womb  being  enlarged  by 
disease,  had  produced  much  the  same  effect  as  if  it  had  been 
enlarged  by  pregnancy,  viz.  obstruction  of  the  urethra  ; for 
the  body  of  the  womb  had  fallen  into  the  hollow  of  the  sacrum, 
and  had  formed  adhesions  there  with  the  rectum,  while  the 
orifice  of  the  womb  pressed  forward  upon  the  os  pubis,  so  as  to 
produce  an  obstruction  of  urine.  The  parts  were  otherwise 
diseased,  but  this  was  one  cause  of  the  obstinacy  and  fatal  de- 
termination of  the  complaint. 

As  we  treat  of  those  subjects  only  as  connected  with  the 
urethra,  we  may  observe,  that  sometimes  the  urethra  takes  a 
course  not  round  behind  the  os  pubis  simply,  nor  straight  up- 
wards, but  curved  backwards,  so  that  the  convexity  of  the  ca- 
theter requires  to  be  towards  the  sacrum,  to  allow  the  point  to 
pass  over  the  orifice  of  the  womb,  or  perhaps  the  flexible,  or 
the  male  catheter  may  be  required. 

The  effect  of  the  wedging  of  the  child’s  head  in  a tedious 
labour,  is  to  elongate  and  compress  the  urethra  in  a very  parti- 
cular manner.  Many  young  men  have  felt  the  difficulty  of  in- 
troducing the  catheter  in  this  case.  But  it  is  a difficulty  pro- 
ceeding generally  from  ignorance,  or  inattention.  I have  ne- 
ver seen  a case  in  which  the  compression  was  so  great  as  to  pre- 
vent the  passing  of  the  catheter.  But  often  practitioners  forget 
the  direction  which  the  urethra  necessarily  takes,  when  the 
child’s  head  has  sunk  into  the  pelvis. 


THE  EXTERNAL  PARTS  OF  GENERATION, 


12$ 


Third  Plan  of  the  Female  Parts. 


Thus,  when  in  the  second  stage  of  the  labour,  the  child’s 
head  A,  has  sunk  into  the  pelvis,  the  urethra  C,  is  pressed  be- 
twixt it  and  the  os  pubis  D.  The  urine  consequently  collects 
in  the  bladder,  and  the  bladder  E,  rises  above  the  brim  of  the 
pelvis,  and  I have  found  it  stretching  to  the  scorbiculus  cordis. 
There  is  danger  from  the  distention  of  the  bladder,  and  the  la- 
bour-pains cease.  Now  the  young  surgeon  or  accoucheur,  in- 
troduces the  catheter  in  the  usual  way,  in  the  position  F,  of 
course  he  finds  great  difficulty,  and  gives  pain  in  the  attempts. 
But  after  inserting  the  point  of  the  catheter,  he  must  incline 
its  handle  much  towards  the  perineum,  as  in  the  inclinations  of 
the  dotted  lines  G,  so  that  the  point  may  glide  up  in  the  direc- 
tion betwixt  the  child’s  head  and  the  pelvis. 

Orificiuji  vagina.  This  is  also  named  orificium  ex- 
ternum, in  opposition  to  the  uterine  orifice.  I notice  it  under 
the  head  of  the  external  parts,  because  we  have  to  speak  of  the 
parts  which  surround  the  orifice  as  the  hymen. 

The  orifice  of  the  vagina  of  the  human  female  is  abridged 
b y the  hymen,  which  is  a peculiar  membrane.  It  is  of  a semi- 


136 


THK  EXTERNAL  PARTS  OF  GENERATION. 


lunar  form,  and  sometimes  surrounds  the  lower  part  of  the  ori- 
fice of  the  vagina  ; — commonly  it  surrounds  only  the  lower  half 
of  the  circle,  though  it  would  seem  to  vary  considerably  in 
shape,  place,  and  strength.  It  has  been  found  surrounding  the 
whole  circle  of  the  orifice,  leaving  only  a small  hole  in  the  cen- 
tre, or  upper  part ; or  it  is  described  as  perforated  with  lesser 
holes,  allowing  the  evacuation  of  the  menstrual  blood.  In 
other  cases,  it  has  been  found  a complete  circle,  preventing  the 
evacuation  of  the  menstrual  blood.  This  is  a fact  which  I do 
not  dispute,  for  I know  that  the  perforation  for  the  evacuation 
of  the  menstrual  blood  is  sometimes  necessary.  When  I have 
seen  the  imperforated  vagina  in  the  child,  it  was  not  the  hymen 
which  closed  the  orifice,  but  an  adhesion  of  its  sides  ; yet  this 
adhesion,  if  it  had  come  to  be  distended  with  the  menstrual 
blood  of  several  periods,  would  have  presented  the  appearance 
of  a tense  membrane  stretched  across  the  orifice. 

Such  a membrane  as  I have  described,  will  occasionally  be 
seen  in  the  female  parts  ; but  it  has  such  an  appearance  as  may 
easily  be  destroyed  in  the  preparation  of  the  parts,  if  the  ana- 
tomist be  inattentive  or  careless.  It  is  neither  a guard,  nor  is 
its  existence  a test  of  female  chastity.  Often  in  tender  chil- 
dren there  is  no  such  thing  to  be  seen  ; while,  on  the  other 
hand,  it  has  been  cut  to  admit  of  labour  and  delivery.*  Either 
of  these  facts  is  sufficient  proof  of  the  idle  notions  entertained 
concerning  this  membrane.  It  has  been  a favourite  topic  in 
all  ages,  and  in  all  situations.  The  savage,  and  the  gentleman, 
make  much  the  same  enquiries  on  visiting  a museum  ; and 
such  was  the  subject  of  Omai’s  speculations  in  the  museum  of 
t)r.  Hunter. 

The  c aruncuLjE  myrtiformes — are  small  and  irregular 
tumours  at  the  back,  or  lower  part  of  the  external  orifice  ; they 
are  seated  rather  at  the  sides  than  exactly  at  the  back  part ; 
they  are  generally  supposed  to  be  the  ruins  of  the  hymen, 
which  being  lacerated,  shrink  into  two  or  three  tumours  on 
each  side.  Some  have  said,  that  these  exist  originally  joined  to- 
gether by  a thin  membrane,  or  delicate  tissue  of  small  vessels, 
the  rupture  of  which  causes  an  effusion  of  blood.  They  seem 
to  be  simply  corrugations  of  the  inner  membrane,  which  serve 
as  a provision  for  the  dilatation  of  the  parts  ; and  they  accord- 
ingly disappear  during  the  passing  of  the  child’s  head. 

The  fossa  navicularis  is  a sinus,  supposed  to  be  of  the 
shape  of  a boat,  whence  its  name.  It  is  formed  betwixt  the 

* I need  not  fay  how  unneceffary  and  improper  fuch  operations  are.  All  rigidity, 
qallofities,  even  tumours,  and  undoubtedly  the  hymen,  will  yield  to  that  general  re- 
laxation of  all  the  parts,  which  takes  place  upon  the  commencement  of  labour. 


OF  THE  BLADDER  OF  URINE. 


137 


proper  orifice  of  the  vagina  and  the  fourchette,  or  joining  of 
the  labise  at  their  lower  edge.  It  is  more  conspicuous  in  young 
subjects. 

From  the  meeting  of  the  labise  below,  the  Perineum  com- 
mences : it  includes  that  space  from  the  frenum  to  the  anus. 


CHAP.  II. 


OF  THE  PARTS  CONTAINED  WITHIN  THE 
FEMALE  PELVIS. 


TThESE  parts  are  the  bladder  of  urine,  Ihe  vagina,  the 
womb,  the  ovaria.  We  shall  consider  them  under  distinct 
sections. 


SECTION  I. 

OF  THE  BLADDER  OF  URINE. 


As  the  coats  of  the  bladder  of  urine  in  woman  do  not  vary- 
from  those  of  the  male  bladder,  we  have  under  this  head  only 
to  notice  the  peculiarities  in  its  relative  situation.  It  is  seated 
behind  the  os  pubis,  and  betwixt  it  and  the  womb  ; and  on  its 
lower  part  it  is  attached  to  the  vagina  ; upon  the  neck  of  the 
bladder,  or  the  beginning  of  the  urethra,  there  is  not  a body 
like  the  prostate  gland  ; and,  as  we  have  seen,  the  urethra  is 
short,  wide,  and  straight,  and  simple  in  its  use. 

Women  are  not  subject  to  calculi,  and  the  operation  for  the 
stone  is  rare  in  them  ; for,  as  already  observed,  when  the 
nucleus  is  formed,  or  when  a stone  slips  down  from  the  pelvis 
of  the  kidney,  it  passes  from  the  bladder  with  much  greater 
facility  than  in  the  male  parts.  The  urethra  of  itself  has  been 
known  to  dilate  so,  as  to  allow  very  large  stones  to  pass,  or  it 
has  been  artificially  dilated.  Indeed  the  old  operation  for  li- 
thotomy, was  rudely  to  dilate,  or  rather  tear,  the  urethra,  and 
the  modern  operation  is  simply  to  thrust  the  gorget  along  the 
Vol.  IV.  S 


138 


OF  THE  BLADDER  OF  URINE. 


grooved  staff,  so  as  to  lay  open  the  side  of  the  urethra  and 
neck  of  the  bladder,  by  an  incision  above  the  vagina.  Some- 
times nature  has  effected  her  own  relief  by  the  stone  working 
from  the  neck  of  the  bladder  into  the  vagina. 

A woman  had  for  a very  long  period  suffered  great  distress, 
not  only  the  ardor  urinse,  frequent  desire  to  make  urine,  with 
the  urine  turbid  and  bloody,  and  with  all  the  usual  symptoms 
of  stone  violently  aggravated  ; but  she  was  delicate  and  timor- 
ous, and  concealed  her  distress  until  the  urine  had  run  for 
some  time  by  the  vagina.  After  she  had  been  exhausted  by 
long  suffering,  her  friends  insisted  that  she  shoultl  allow  an  ex- 
amination, when  a stone  was  found  partly  in  the  bladder, 
with  one  of  the  rough  ends  projecting  into  the  vagina.  The 
opening  was  enlarged,  and  the  stone  extracted. 

We  must,  in  all  cases,  recollect  the  connection  of  the  upper 
part  of  the  vagina  and  orifice  of  the  womb,  with  the  back  part 
of  the  bladder.  We  have  seen  its  effect  in  producing  re- 
troversio  uteri.  We  must  also  attend  to  this  connection,  as 
tending  to  the  displacement  of  the  bladder  in  the  procidentia 
uteri.  The  uterus  sinking  into  the  vagina,  and  the  upper  part 
of  the  vagina  being  at  the  same  time  reflected  into  the  lower 
part,  pulls  down  the  bladder  with  it,  and  when  (the  disease  in- 
creasing) the  womb  covered  by  the  vagina  comes  to  hang  from 
the  external  parts,  it  has  happened  that  the  bladder  has  sunk 
down  and  lain  upon  the  fore  part  of  the  tumour,  but  of  course 
within  the  everted  vagina.. 

Fourth  Plan. 

Section  (hewing  the  effect  of  Procidentia  on  the  Bladder. 


">  OF  THE  VAGINA,  ETC.  1 3£) 

Thus,  by  comparing  this  fourth  plan  with  the  first  of  the 
female  pelvis,  we  may  judge  of  the  nature  of  this  displace- 
ment of  the  womb,  and  its  effects  on  the  bladder  of  urine. 

A,  the  os  pubis  ; B,  the  sacrum  ; C,  the  intestines  come 
into  the  situation  of  the  womb  ; D,  the  uterus  fallen  down, 
and  carrying  the  vagina  before  it  ; E,  the  vagina  still  covering 
the  womb,  but  the  orifice  of  the  womb  appearing,  which  is 
generally  distorted  and  irregular  ; F,  the  bladder,  which, 
from  its  attachment  to  the  fore  part  of  the  vagina,  has  been 
dragged  down,  but  is  now  within  the  vagina. 

In  such  displacement  of  the  bladder,  the  urethra  becomes 
distorted  from  its  natural  direction,  there  is  an  obstruction  of 
urine,  and  the  catheter  is  with  great  difficulty  introduced. 
We  shall,  perhaps,  have  to  turn  the  handle  of  the  catheter  in 
various  directions  after  introducing  the  point,  and  bv  chance 
get  it  introduced  at  last. 


SECTION  II. 


OF  THE  VAGINA  J OF  ITS  SHAPE,  CONNECTIONS,  ETC. 

The  vagina  is  a tube  stretching  from  the  external  orifice  to 
the  orifice  of  the  womb.  Its  orifice  is  bounded  below  by  the 
fourchette  ; above  by  the  arch  of  the  pubes  ; and  directly  over 
it,  or  sometimes  within  it,  is  the  orifice  of  the  urethra  ; below, 
are  the  carunculse  myrtiformes.  It  is  surrounded  by  fasciculi 
of  fibres,  which  are  called  the  sphincter  muscle.  The  canal 
of  the  vagina  is  of  a conical  form.  At  the  outer  orifice  it  is 
constricted  by  the  sphincter  muscle  ; but  it  is  wider  within, 
and  where  it  receives  the  orifice  of  the  womb.  It  may  be 
distended  to  almost  any  degree,  but  naturally  its  sides,  by  their 
own  elasticity,  or  the  contraction  of  the  surrounding  fibres,  or 
the  pressure  of  the  surrounding  parts,  are  in  contact. 

In  the  natural  state,  the  orifices  of  the  vagina  and  womb, 
are  but  three  or  four  inches  distant,  often  only  two  ; and  some- 
times, where  there  is  a degree  of  relaxation,  they  are  nearly 
in  contact.  In  the  first  months  of  pregnancy,  the  orifice  of 
the  womb  is  kept  down  by  the  degree  of  difficulty  the  body  of 
the  womb  has  in  shooting  up  from  the  brim  of  the  pelvis.  But 
the  gravid  uterus  rising  above  the  pelvis  in  the  latter  months, 
draws  up  the  orifice  of  the  womb,  and  stretches  the  vagina. 

The  vagina  bends  gently  round  the  pubes  as  it  were,  or  foJU 


140 


OB'  THE  VAGINA,  ETC. 


lows  the  axis  of  the  pelvis  ; and  as  the  interior  of  two  circles 
cut  off  by  the  same  radii  is  the  shorter,  the  vagina  is  longer 
behind  than  before. 


And  thus  (in  this  fifth  plan ) the  fore  part  of  the  vagina  A,  is 
shorter  than  the  back  part  B.  We  may  observe  from  this  plan 
also,  that  the  orifice  of  the  womb  C,  projects  as  it  were  into 
the  vagina,  so  that  the  finger  touches  the  os  tincae,  and  chiefly 
its  anterior  lip,  without  reaching  the  upper  part  of  the  vagina. 

The  vagina  takes  its  curve  nearly  in  the  centre  of  the  pelvis  ; 
it  is  of  necessity  attached  by  cellular  substance  to  the  rectum 
and  bladder.  The  urethra,  as  we  have  said,  opens  above  the 
orifice,  and  that  canal  is  attached  to  the  vagina  in  its  whole 
length;  and  the  neck  of  the  bladder  is  attached  to  the  upper 
part.  In  consequence  of  this  natural  connection,- disease  of 
the  vagina  sometimes  throws  the  whole  parts,  the  rectum, 
vagina,  and  bladder,  into  one  fistulous  ulcer. 

The  vagina  has  three  coats  ; that  is  to  say,  it  has  the  inner 
coat,  or  surface,  a few  muscular  fibres,  and  around  it  a con- 
densation of  the  surrounding  cellular  membrane,  which  mat 
be  considered  as  the  third  coat. 

The  internal,  or  villous  coat,  is  a reflexure  of  the  delicate 
covering  of  the  external  parts.  It  is  of  larger  extent,  or 
longer  than  the  others  ; and  is  therefore  tucked  up  into  rugae, 
which  run  across  the  vagina.  They  are  more  remarkable  on 
the  fore  and  back  part  of  the  vagina  ; they  are  less  in  married 
women,  and  considerably  obliterated  by  repeated  labours. 

To  supply  a viscous  secretion  for  the  defence  of  this  surface. 


141 


OF  THE  VAGINA,  ETC. 

mucous  glands  are  numerously,  but  irregularly  scattered  over 
it,  and  they  are  particularly  numerous  at  the  orifice. 

The  muscular  coat  is  not  very  strong,  nor  are  the  fibres 
distinct,  from  which  some  have  suspected  their  existence, 
alleging,  that  there  is  here  only  condensed  cellular  membrane, 
and  that  the  contraction  of  the  vagina  is  the  effect  of  mere 
elasticity.  I observe  so  great  a profusion  of  venous  vascularity, 
that  I presume  the  vagina  suffers  an  inflation  of  its  coats,  and 
consequently  contraction  from  an  afflux  of  blood  to  it.  The 
muscular  fibres  are,  however,  as  we  have  said,  gathered  into 
fasciculi  near  the  orifice,  so  as  to  be  distinctly  visible. 

The  firmness  and  stricture  of  the  vagina  support  the  womb  ; 
the  dilatation  of  the  vagina,  the  relaxation  which  old  age,  and 
frequent  labours  produce,  occasion  the  falling  down  of  the 
womb.  It  is  a disease  almost  peculiar  to  those  who  have  borne 
many  children,  to  the  old,  weak,  and  relaxed,  and  to  those 
who  are  subject  to  the  fluor  albus  ; every  flux  from  the  womb, 
or  discharge  from  the  vagina,  havmg  a remarkable  effect  in 
relaxing  the  parts. 

This,  from  the  nature  of  the  parts,  must  be  an  increasing- 
disease  ; for  no  sooner  has  the  womb  fallen  down  into  the  va- 
gina, than  it  becomes  a source  of  irritation,  excites  a bearing- 
down  pain  like  tenesmus,  an  uneasy  sensation,  a desire  to 
make  urine,  and  an  obstruction  of  urine  ; all  which  is  ex- 
plained by  the  connection  of  the  parts.  The  womb  lodging  in 
the  vagina  dilates  the  orifice,  and  presses  long  on  the  peri- 
neum, at  last  it  is  entirely  forced  out,  and  the  prolapsus  uteri 
becomes  the  procidentia  uteri : it  is  in  truth  a hernia  of  the 
womb. 

The  third,  and  outer  coat,  as  we  have  said,  is  formed  of  the 
cellular  membrane,  by  which  it  is  connected  with  the  sur- 
rounding parts  ; but  the  peritoneum  comes  down  upon  the 
upper  part  of  the  vagina.  This  is  the  reason  wrhy  a portion  of 
the  intestine,  when  it  slips  down  betwixt  the  vagina  and  rectum, 
forms  a kind  of  hernial  tumour  in  the  vagina,  and  why  the 
water  of  ascites  has  pushed  down  the  back  of  the  vagina,  so 
as  to  make  a bag  capable  of  being  punctured  to  draw  off  the 
water. 

For  the  greater  space,  however,  the  outer  cellular  coat  of 
the  vagina  connects  it  with  the  urethra  oil-  the  fore  part,  and 
-with  the  rectum  behind.  From  which  close  connection  oi 
parts,  we  see  the  consequence  of  the  delay  of  the  child’s  head 
in  the  second  stage  of  labour,  that  the  head  lies  violently 
distending,  and  compressing  the  parts,  while  the  woman,  ex- 
hausted by  the  previous  stage,  is  unable  to  complete  the  deli- 
very. From  violent  inflammation,  with  a deficiency  ofsecre- 


142 


OF  THE  WOMB. 


tion,  there  arises  a cold  and  flabby  state  of  the  parts.  When 
the  woman  is  delivered,  the  parts  have  suffered  so  much,  that 
they  slough  off  ; sometimes  the  urethra  is  laid  open  on  the  fore 
part,  and  sometimes  the  rectum  behind. 


SECTION  III. 


OF  THE  WOMB. 


6th  Plan  of  the  Female  Parts. 


This  little  drawing  will  better  explain  the  figure  of  the 
womb,  when  dissected  from  the  vagina  and  surrounding 
membranes,  than  the  usual  necessary  reference  to  a bottle,  a 
pear,  or  a powder-flask.  As,  indeed,  it  strictly  resembles  no 
familiar  object  that  I know,  we  must,  for  the  convenience  of 
description,  distinguish  it  into  these  parts  : — The  upper  part, 
or  fundus,  which  is  that  part  above  the  going  off  of  the  Fallo- 
pian tubes.  The  body  of  the  uterus,  which  is  that  larger 
part  betwixt  the  fundus  and  the  narrowing  below  ; the  cer- 
vix, which  is  the  narrow  neck  ; and  the  os  tinc/E,  or  orifice 
formed  of  the  bulging  lips,  which  project  into  the  vagina,  of 
course  that  part  over  which  the  inner  membrane  of  the  vagina 
is  reflected.  We  distinguish  also  the  two  surfaces,  for  the 
womb  is  of  a flattened  form.  The  anterior  surface  of  the 


OF  THE  WOMB. 


wk 

body  of  the  womb  is  convex,  but  the  posterior  surface  is  con- 
siderably more  so,  and  even  during  gestation  it  keeps  this  re- 
lative figure. 

The  whole  size  of  the  uterus  is  about  three  inches  in  length, 
and  two  in  breadth,  but  there  is  a very  great  variety  in  this 
respect,  from  age,  the  effect  of  pregnaricies,  and  other  causes. 
When,  in  its  usual  situation  and  relations,  the  fundus  is  on  a 
level  with  the  brim  of  the  pelvis,  or  a very  little  below  it.  In 
the  fetus,  the  womb  is  like  the  bladder,  considerably  above 
the  brim  of  the  pelvis  ; but,  in  a few  weeks  the  pelvis  enlarg- 
ing, it  sinks  deeper,  and  soon  assumes  the  same  situation  as  in 
the  adult. 

Fallopian  tubes.  From  the  lateral  obtuse  angles  formed 
betwixt  the  fundus  and  the  body  of  the  uterus,  the  Fallopian 
tubes  are  continued.  These  tubes  may  almost  be  considered 
as  a continuation  of  the  uterus,  did  not  we  find  them  so  very 
distinct  in  their  substance.  They  are  about  three  inches  in 
length,  take  a tortuous  course,  and  their  extremities  have  an 
unequal  fringed  termination,  which  is  called  the  fimbria. * 
Their  canal  is  very  small  towards  the  uterus,  but  enlarges,  and 
is  patulous  towards  the  extremities.  These  canals  are  the 
communications  by  which  the  ovum  formed  in  the  ovarium  is 
carried  down  into  the  womb. 

Ligaments  of  the  uterus.  To  support  the  uterus  from 
sinking  too  deep  into  the  pelvis,  and  to  steady  it,  and  direct  it 
in  its  ascent  during  pregnancy,  anatomists  have  generally  as- 
signed as  the  use  of  the  ligaments.  But  whatever  good  they 
may  do  in  the  latter  operation,  they  are  certainly  unfit  for  the 
former. 

There  are  four  ligaments  of  the  uterus. 

The  broad  ligament  of  the  uterus  is  formed  of  the  peri- 
toneum ; for  this  membrane  passing  down  before  the  rectum, 
and  ascending  again,  and  covering  the  neck,  body,  and  fundus 
of  the  womb,  descends  on  the  fore  part,  so  as  to  reach  the  va- 
gina before  it  rises  over  the  bladder.  Thus  it  invests  the  womb 
as  it  does  the  abdominal  viscera.  This  investing  of  the  womb 
with  the  peritoneum  is  indeed  a provision  for  its  becoming;  an 
abdominal  viscus,  for  in  pregnancy  it  rises  .out  of  the  pelvis; 
and,  being  distended  before  the  bowels,  assumes  in  every 
respect  that  relation  totfhe  peritoneum  which  they  have. 

As  the  womb  then  is  included  betwixt  the  duplicature  of  the 
peritoneum,  it  is  this  peritoneal  coat,  which  being  continued 
off  laterally,  forms  the  broad  ligament  of  the  womb.  This 
duplicature  of  the  peritoneum  being  a thin  expansion  of  it, 


Morfus  diaboli. 


J44 


OF  THE  WOMB. 


has  sometimes  had  the  name  of  ALvE  vispertilionis  : It  is  m 
truth  like  a mesentery  to  the  womb  and  Fallopian  tubes,  and 
serves  equally  to  support  and  convey  the  vessels  to  them.  The 
womb  and  the  two  ligaments  make  a complete  partition  running 
across  the  pelvis. 

From  the  side  of  the  uterus,  a little  below,  and  before  the 
going  off  of  the  Fallopian  tubes,  the  round  ligaments  arise. 
I consider  these  ropes  as  ligaments,  but  they  are  totally  unlike 
any  common  ligament.  They  seem  intended  to  give  the  due 
inclination  forward,  and  to  direct  the  uterus  in  its  ascent  in 
pregnancy,  and  accordingly  they  are  not  merely  condensed  and 
unelastic  cellular  membrane  ; but,  on  the  contrary,  they  are 
composed  of  fibres,  with  an  intermixture  of  blood  vessels,  so 
that  whilst  they  keep  a degree  of  tension  on  the  uterus,  they 
yield  and  grow  not  only  in  length,  but  in  thickness  and 
strength,  as  the  uterus  ascends  in  the  advanced  pregnancy  : 
they  pass  through  the  abdominal  ring,  and  are  attached  to  the 
cellular  membrane  of  the  top  of  the  thigh.  In  the  gravid 
uterus,  both  the  broad  and  the  round  ligaments  considerably 
alter  their  position,  appearing  to  rise  lower,  and  more  forward 
from  the  womb  than  in  the  unimpregnated  state.  This  is  in 
consequence  of  the  greater  increase  of  the  fundus  of  the 
womb,  in  proportion  to.  the  lower  part  of  it. 

OF  THE  CAVITY  OF  THE  UTERUS. 

Sixth  Plan. 


The  cavity  of  the  uterus  is  properly  confined  to  the  fundus 
and  body,  and  takes  a triangular  figure.  In  the  cervix,  it  is 
more  like  a canal,  and  differs  essentially  from  the  proper  ca- 


OF  THE  WOMB. 


145 


vity.  A,  the  cavity  of  the  uterus  ; B,  the  continued  cavity, 
%vhere  it  is  very  narrow  towards  the  cervix.  C,  the  canal  of 
the  cervix , where  it  has  an  enlargement  like  a sinus.  The 
Fallopian  tubes  going  off  from  the  cavity  of  the  uterus. — • 
These  angles  of  the  cavity  admit  no  more  than  a hog’s  bristle. 
The  third  angle,  towards  the  neck,  is,  of  course,  considerably 
larger.  The  proper  triangular  cavity  of  the  uterus  is  lined 
with  a peculiar  soft  and  delicate  membrane  ; it  is  very  vascular, 
and  the  vessels  either  open  on  th^surface  naturally,  or  bursting 
out  from  time  to  time,  pour  out  the  menstrual  blood.  The  canal 
of  the  cervix  shows  a very  different  surface.  We  observe  a 
prominent  longitudinal  line  on  the  fore  and  back  part  of  it, 
from  which  oblique  and  transverse  rugae  go  out.  The  surface 
is  firmer  and  callous,  and  less  vascular.  Betwixt  the  rugae 
there  are  lacunae,  which  throw  out  a mucilaginous  fluid  ; and 
towards  the  orifice  we  see  these  larger,  and  sometimes  distinct 
glandular  bodies. 

This  peculiar  shape  of  the  cavity  of  the  womb,  and  the 
hardness  and  small  degree  of  vascularity  of  the  lowrer  part,  is 
of  the  most  essential  importance.  The  upper  part,  the  proper 
cavity  of  the  womb,  is  prepared  for  the  reception  and  imme- 
diate adhesion  of  the  ovum,  when  it  shall  have  descended 
through  the  Fallopian  tube  ; but  the  long  callous  cervix  is 
provided,  that  there  may  be  no  adhesion  to  the  lower  part  of 
the  womb,  and  that  the  placenta  may  not  form  over  the  orifice 
of  the  womb,  for  if  it  should,  the  most  dangerous  kind  of 
flooding  takes  place  on  the  approach  of  labour  from  the  open- 
ing of  the  orifice,  and  the  tearing  open  of  the  adhesions  of  the 
plgcenta,  before  the  child  can  be  delivered.  The  length  of  the 
cervix,  and  the  glandular  structure  of  the  orifice  is  also  of 
much  importance  in  sealing  up  the  cavity  of  the  womb  after 
conception,  that  there  may  be  no  longer  communication  with 
the  vagina  ; for  this  purpose,  a viscid  tenacious  mucus  is 
poured  out  ; but,  on  the  approach  of  labour,  with  the  soften- 
ing and  relaxation  of  all  the  soft  parts,  this  adhesion  and 
gluing  up  of  the  orifice  is  dissolved,  and  a more  fluid  secretion 
is  poured  out. 

From  the  cavity  of  the  womb  the  menstrual  blood  is  dis- 
charged at  certain  periods,  from  the  time  of  puberty  to  the 
approach  of  old  age,  when  the  system  is  no  longer  capable  of 
giving  nourishment  to  the  fetus.  We  shall  presently  find, 
that  the  subserviency  of  menstruation  merely  to  the  prepara- 
tion of  the  surface  of  the  womb  for  the  reception  of  the  fetus, 
though  it  be  a principal,  is  by  no  means  the  sole  end  of  this 
periodical  discharge. 

It  was  long  disputed  from  what  source  the  menstrual  dis- 
Vol.  IV.  T 


146 


or  THE  WOMB. 


charge  flowed.  Some  affirmed,  that  it  must  flow  from  the  va- 
gina, and  not  from  the  womb,  because  it  flowed  sometimes 
during  gestation.  This  is  a fact  which  cannot  be  denied.  I 
have  attended  a patient  who  menstruated  during  the 'entire 
period,  or  to  the  eighth  month  ; and  I have  often  observed 
ladies  to  menstruate  at  the  first  period  after  conception.  On 
the  other  hand,  we  have  every  proof  of  the  discharge  being 
from  the  orifice  of  the  womb.  For  instance,  some  have  ob- 
served on  dissection  of  the  parts  of  women  dying  during  the 
flow  of  menses,  that  blood  was  effused  under  the  delicate 
membrane  of  the  cavity  of  the  womb.  The  vessels  there 
have  been  observed  particularly  turgid,  or  the  whole  surface 
of  the  proper  cavity,  and  especially  the  fundus,  spotted  with 
bloody  effusions.  More  particular  observation  has  shewn, 
not  only  the  mark  of  blood  poured  out  from  the  inner  surface, 
but  that  the  whole  substance  of  the  womb  whs  become  thick, 
soft,  and  vascular  and  M-  Littre  affirms,  that  in  the  body  of 
a woman  who  had  died  during  menstruation,  and  with  a con- 
ception in  the  Fallopian  tube,  he  found  a layer  of  red  coagu- 
lated blood  ; upon  removing  which,  he  saw  a number  of  small 
foramina  which  admitted  bristles.'!' 

But  the  best  and  least  equivocal  proof  is,  that  which  has 
been  repeatedly  observed  in  the  inversion  of  the  womb,  when 
the  inner  surface  has  been  turned  out  after  labour,  and  has  re- 
mained thus  inverted,  and  protruding  from  the  external  parts, 
for  then  the  menstrual  blood  has  been  seen  to  distil  from  the 
surface  of  the  cavity  of  the  uterus. 

OF  THE  BLOOD-VESSELS  OF  THE  WOMB. 

These  are  four  large  arteries  which  supply  the  system  of  the 
womb,  and  four  large  veins  which  return  the  blood. 

The  spermatic  arteries  come  down  from  the  aorta  itself, 
or  from  the  renal  or  capsular  arteries.  The  spermatic  artery 
taking  a waving  direction,  becomes  tortuous  in  a most  re- 
markable degree  as  it  approaches  the  uterus,  it  is  distributed 
to  the  Fallopian  tube,  the  ovarium,  but  chief!)'  to  the  body  and 
fundus  of  the  uterus,  where  it  forms  remarkable  anastamoses 
with  the  artery  of  the  other  side. 

The  low  ; r artery — the  uterine  artery,  comes  in  ge- 
neral from  the  hypogastric  artery,  takes  also  a serpentine 
course,  and  is  distributed  to  the  vagina,  and  the  lower  part  of 

* The  authorities  upon  this  fubjedt  are  Spigelius,  Morgagni,  M.  Littre, 
Mauriccau,  Winflow,  Sympfon. 

f This  might  have  been  an  early  abortion,  or  perhaps  the  decidua  which  it  h 
laid  is  fometimes  formed  at  the  menltrual  period. 


OF  THE  WOMB. 


14  7 


the  uterus,  and  inosculates  largely  with  the  other  vessels,  both 
in  the  uterus,  and  by  particular  branches  on  the  side  of  the 
uterus. 

In  the  first  place,  it  appears,  that  this  copious  supply  of  ves- 
sels to  the  uterus,  from  four  different  sources,  is  a provision 
that  the  womb  and  secundines  shall  not  by  any  accident  of  po- 
sition, or  by  the  progress  of  labour,  and  the  consequent  com- 
pression of  one  or  both  the  lower  vessels,  be  deprived  of  their 
due  supply  of  blood.  Again,  their  tortuous  forms  give  proof 
of  their  occasional  greater  activity,  that  they  admit  of  a pecu- 
liar and  local  action  during  menstruation,  and  that  the  blood 
will  move  more  languidly  when  the  stimulus  of  the  womb  has 
ceased.  It  is  also  a provision  for  the  growth  and  increase  of 
the  womb,  and  the  supply  of  nourishment  to  the  ovum.  And 
that  an  increased  activity  in  a part  must  be  supplied  by  a more 
tortuous  form,  as  well  as  an  enlargement  of  the  calibre  of  the 
vessels,  is  in  a particular  manner  illustrated  by  the  change  which 
takes  place  in  these  vessels  during  pregnancy.  For  they  be- 
come in  a much  more  remarkable  degree  tortuous  and  en- 
larged. 

The  substance  of  the  uterus  is  said  to  be  spongy  and  com- 
pact, which,  though  it  is  a seeming  contradiction  in  words,  does 
yet  really  convey  an  idea  of  the  effects  of  its  copious  intertex- 
ture of  vessels.  Some  have  said,  (as  Mauriceau,)  that  by 
pregnancy  the  womb  is  distended,  and  grows  thinner  : others, 
that  it  grows  thicker,  as  Daventer  : and  others  again,  as  Smel- 
lie,  assert,  that  it  continues  of  its  natural  thickness.  These  as- 
sertions are  none  of  them  perfectly  correct : for  the  womb  is 
not  distended  by  the  growth  of  the  fetus  and  membranes,  but 
grows  with  them.  Again,  that  the  substance  of  the  womb 
grows  in  a remarkable  degree,  is  true,  but  still  when  distended 
by  the  waters  in  the  last  months  of  pregnancy,  its  walls  are  thin- 
ner than  in  the  unimpregnated  state.  Thus,  when  it  has  been 
cut  in  the  living  body,  upon  the  approach  of  labour,  in  the  Cae- 
sarean section,  I have  observed  it,  not  more  than  a quarter  of  an 
inch  in  thickness,  even  at  the  part  to  which  the  placenta  adhe- 
red. When  I have  dissected  the  womb  after  a tedious  labour, 
the  waters  discharged,  but  the  head  wedged  in  the  pelvis,  I 
have  found  it  considerably  thicker.  And,  lastly,  in  the  full 
contraction  of  the  womb,  after  expelling  the  fetus  and  placen- 
ta, (for  example,  in  rupture  of  the  womb,  where  the  child  and 
placenta  had  been  forced  amongst  the  bowels,  and  the  woman 
soon  after  died,)  I found  the  walls  of  the  womb  about  three, 
quarters  of  an  inch  in  thickness. 


148 


OF  THE  womb- 


SECTION  IV. 

OF  THE  OVARIA. 

The  ovaria  are  two  oval  bodies,  which  are  suspended  in  the 
broad  ligament  behind,  and  a little  below  the  Fallopian  tubes  : 
while  they  have  an  oval  figure,  they  are  somewhat  flattened. 
By  cutting  out  the  ovaria,  the  animal  loses  the  power  of  con- 
ceiving, and  desire  is  extinguished  ; they,  therefore,  bestow 
what  is  essential  to  generation  upon  the  part  of  the  female.  In 
vague  speculations  on  the  subject  of  generation,  they  were  sup- 
posed to  prepare  a female  semen  ! but  more  particular  exami- 
nation demonstrates,  that  they  consist  of  vesicles,  which  are 
ova  ; but  how  far  incomplete,  or  in  what  essential  circumstance 
requiring  the  approach  of  the  male,  is  not  determined. 

When  we  hold  the  section  of  the  ovarium  betwixt  the  eye 
and  the  light,  we  see  a great  many  polluted  vesicles  ; and  if 
we  examine  the  ovarium  of  an  animal  killed  in  full  health,  and 
particularly  in  the  season,  we  shall  observe  these  ova  to  be  in 
all  varieties  of  states  of  preparation  for  impregnation.  Some 
small  and  pellucid,  and  yet  only  discernible  in  the  thick  outer 
coat,  by  having  a degree  of  greater  transparency ; others,  which 
have  taken  a slight  tinge  of  bloody  colour  from  vessels  striking 
into  them  ; and  if  the  section  be  made  after  a minute  injection, 
the  vesicles  will  be  seen  coloured  in  the  proportion  of  their 
maturity  ; some  without  a speck  of  colour  ; others  tinged  ; one 
or  two  loaded  with  injection  ; and  some  vascular,  and  particu- 
larly prominent. 

In  very  young  girls,  the  substance  of  the  ovarium  is  whitish, 
and  very  soft ; the  surrounding  membrane  is  thick  ; and  the 
round  corpuscules  scarcely  discernible  ; and  no  irregularities, 
nor  any  of  those  bodies  called  corpora  lutea,  are  to  be  seen  on 
the  surface.  But  as  the  girl  advances  in  years,  the  little  vesi- 
cles begin  to  appear,  and  when  about  ten  years  of  age,  or  just 
before  menstruation,  the  ovarium  is  full  of  ova  of  various  sizes, 
and  some  of  them  more  matured,  and  forming  an  eminence 
upon  the  surface.  In  the  adult  woman,  the  substance  of  the 
ovarium,  which  appeared  as  an  uniform  homogeneous  mass  in 
the  fcEtus,  is  become  a cellular  and  vascular  bed,  giving  nourish- 
ment to  those  numerous  vessels  or  ova.  Before  impregnation 
can  take  place,  there  must  be  a certain  state  of  preparation  of 
the  ovaria,  without  which  the  approach  of  the  male  effects  no 
change  in  the  uterine  system.  The  lower  animals  having  their 
seasons,  and  these  seasons  being  a state  of  preparation  for  the 
male,  impregnation  follows  the  copulation  with  much  certain- 


OF  THE  WOMB. 


149 


ty  : but,  in  women,  such  a periodical  revolution  in  their  system, 
and  instinctive  desires,  would  but  ill  accord  with  that  superio- 
rity in  attributes  of  the  mind,  which  distinguish  us  in  the  scale 
of  beings.  But  women  also  suffer  such  an  occasional  excite- 
ment in  the  uterine  system,  though  unaccompanied  with  de- 
sires, which  preserves  the  womb  in  a state  of  preparation  for 
the  reception  of  the  ovum,  and  the  ovaria  in  a state  of  prepa- 
ration for  impregnation.  This  is  the  effect  of  menstruation. 

OF  PUBERTY. 

Authors  have  long,  with  many  expressions  of  surprize,  la- 
boured to  assign  a cause,  or  frame  a theory  for  the  explanation 
of  those  changes  which  we  observe  in  woman  at  the  age  of  pu- 
berty : and  generally,  in  their  theories,  they  have  connected 
with  these  changes  the  monthly  and  periodical  discharges  of 
blood  from  the  uterus,  which  commences  with  puberty.  These 
theories  have  been  founded  in  general,  on  principles  remote 
from  the  laws  of  a living  system.  At  this  period  of  puberty, 
the  whole  frame  is  expanded  into  the  fulness  of  feminine  beau- 
ty ; the  breasts  rapidly  increase,  and  are  matured  ; the  parts 
of  generation  are  enlarged  ; the  hair  of  the  pubes  grows,  and 
the  menses  flow.  In  explanation  of  these  changes,  theoretical 
conjectures  after  this  model  have  been  entertained.  “ About 
this  time  the  growth  of  the  body  begins  considerably  to  dimi- 
nish, and  the  blood  finding  easy  admittance  into  the  completed 
viscera  is  prepared  in  greater  quantity,  the  appetite  being  now 
very  sharp  in  both  sexes,  a plethora  consequently  follows.  In 
the  male  it  vents  itself  frequently  by  the  nose,  from  the  exhaling 
vessels  of  the  pituitary  membrane  being  dilated,  fxc.  ; and  now 
the  semen  first  begins  to  be  secreted,  and  the  beard  to  grow. 
But,  in  the  female,  the  same  plethora  finds  a more  easy  vent 
downwards,  being  that  way  directed,  partly  by  the  weight  of 
the  blood  itself  to  the  uterine  vessels,  now  much  enlarged,  of 
a soft  fleecy  fabric,  seated  in  a loose  hollow  part,  with  a great 
deal  of  cellular  fabric  interspersed,  which  is  very  yielding  and 
succulent,  as  we  observe  in  the  womb  : for  these  causes,  the 
vessels  being  easily  distensible,  the  blood  finds  a more  easy 
passage  through  the  very  soft  fleecy  exhaling  vessels  which 
open  into  the  cavity  of  the  uterus,  as  being  there  less  resisted 
than  in  its  return  by  the  veins,  or  in  taking  a course  through 
any  other  part ; because,  in  females,  we  observe  the  arteries  of 
the  head  are  both  smaller,  in  proportion,  and  of  a more  firm  re- 
sisting texture.  The  return  of  the  same  is,  therefore,  more 
slow,  both  because  the  flexures  of  the  arteries,  from  the  in- 


150 


OF  THE  WOMB. 


creased  afflux  of  the  blood,  become  more  serpentine  and  fit  for 
retarding  the  blood’s  motion,*  and  likewise,  because  it  now 
returns  with  difficulty  through  the  veins.  The  blood  is  there- 
fore first  collected  in  the  vessels  of  the  uterus  ; next,  it  is  ac- 
cumulated in  the  arteries  of  the  loins,  and  the  aorta  itself, 
which  urging  on  a new  torrent  of  bloocl,  augments  the  force  so 
far  as  to  discharge  the  red  blood  into  the  serous  vessels,  which 
at  first  transmit  an  increased  quantity  of  warm  mucus,  after- 
Avards  a reddish  coloured  serum,  and  by  suffering  a greater  dis- 
tention, they  at  last  emit  the  red  blood  itself.  The  same  greater 
impulse  of  blood  determined  to  the  genitals,  drives  out  the 
hitherto  latent  haiis,  increases  the  bulk  of  the  clitoris,  dilates 
the  cavernous  plexus  of  the  vagina,  and  whets  the  female  ap- 
petite to  venery,  &c.” 

We  cannot  give  implicit  trust  to  such  speculation,  we  cannot 
believe  in  this  plethora,  produced  by  the  diminished  growth  of 
the  limbs  ; neither  can  we  believe  that  congestion  and  plenitude 
is  produced  in  the  female  system,  from  the  deficiency  of 
perspiration,  from  their  more  lax  and  weaker  solids  compared 
with  man,  from  their  indolent  and  sedentary  life  : for  facts  are 
in  direct  contradiction.  The  growth  and  completed  function  of 
parts  at  this  particular  age,  is  not  to  be  explained  bv  any  theory 
so  partially  applicable  ; during  almost  every  period  of  life, 
there  are  similar  changes  taking  place  in  some  one  part  of  the 
body.  Paris  lie  dormant,  and  are  stationary  in  their  growth, 
which  at  a particular  and  stated  age  of  the  animal,  enlarge  and 
develope  themselves  by  a new  and  invigorated  action.  Ob- 
serve how  different  the  proportions  of  the  foetus  are  from  those 
of  the  adult.  We  see  nature  careful  to  perfect  certain  parts, 
as  the  head  and  liver,  at  an  early  period.  We  see  during  early 
childhood  how  the  parts  shoot  out,  and  evolve  in  due  propor- 
tion. We  see  parts  which  were  large  in  the  foetus  lose  their 
preponderance  : we  see  others,  which  served  some  purpose  in 
the  foetal  system,  gradually  shrink  and  disappear,  because  they 
have  no  longer  the  stimulus  to  action  in  the  circle  of  connec- 
tions Avhich  take  place  in  the  adult  system.  We  find  other 
parts,  as  the  teeth,  for  example,  lying  long  within  the  jaw, 
instead  of  proceeding  with  a gradual  and  continual  enlarge- 
ment, suddenlv  rising  at  certain  stated  periods  from  their 
embryo  state,  and  enlarging  and  pushing  up  through  the  gums, 
when  it  becomes  fit  that  the  child  should  take  more  solid  food 
than  the  mother’s  milk.  So  the  second  set  of  teeth,  in  a more 
particular  manner,  lie  quite  stationary  in  their  growth  within 

* I have  fhown  that  the  tortuous  arteries  always  form  a provifion  for  the  oc- 
cafional  increafe  of  the  action  and  acceleration  of  the  blood. 


OF  THE  WOMB. 


151 


their  little  sacs,  yet  quickly,  at  stated  periods,  they  increase, 
the  enamel  is  formed,  and  they  rise  above  the  gum.  There  is 
an  infinite  number  of  such  changes  depending  upon  the  same 
laws  of  the  oeconomy,  and  not  different  from  those  which  con- 
troul  the  growth,  and  direct  the  shape  of  parts.  They  depend 
upon  certain  laws  of  the  constitution,  which  give  an  excite- 
ment to  certain  parts,  at  stated  periods,  and  which  no  theory 
partially  applicable  will  explain.  There  is  a series  in  which 
the  parts  of  an  animal  body  are  matured,  and  a succession  in 
v/hich  the  functions  are  brought  to  maturity  : and  in  the  female 
constitution,  there  are  laws  determining  an  action  upon  the 
womb  and  breasts,  and  all  parts  subservient  to  conception  and 
the  nourishment  of  a foetus  ; at  that  period  when  the  woman  is 
arrived  at  the  age  fit  to  take  upon  her  the  part  of  a mother. 

OF  MENSTRUATION. 

Under  this  head,  I shall  confine  myself  to  such  a general 
view  of  the  subject,  as  is  necessarily  connected  with  the  pecu- 
liar functions  we  are  now  endeavouring  to  comprehend. 

Menstruation  is  a state  of  preparation  for  conception. 
When,  therefore,  the  menses  flow  at  the  natural  periods,  and 
in  due  quantity,  it  is  a sign  that  the  woman  may  conceive, 
and  that  her  system  is  fit  for  the  support  and  nourishment  of  a 
child.  It  is  a general  affection  of  the  system,  which  has  a 
tendency  to  relieve  itself  by  a topical  action,  by  the  excited 
action  of  the  uterine  system  ; and  this  excitement  of  the 
uterine  system  is  the  end  which  nature  is  accomplishing.  To 
explain  this,  I may  be  allowed  to  take  a short  preliminary 
view  : each  particular  organ  or  viscus,  whilst  it  has  its  con- 
nections with  the  general  system,  is,  in  truth,  a system  within 
itself,  having  its  peculiar  functions,  sympathies,  and  even 
vascular  action,  in  a certain  degree,  independently.  Were 
not  this  in  some  measure  the  case,  we  should  see  no  local  dis- 
ease or  topical  action  ; and  no  vascular  action  could  be  for  a 
moment  stationary  and  confined  to  one  part.  The  body  would, 
indeed,  be  then  only  one  great  hydraulic  machine.  But  while 
the  several  parts  have  the  property  of  being  excited  separately 
to  an  accelerated  action,  they  are  actuated  by  remote  sympa- 
thies, and  by  these  sympathies  and  relations,  is  the  whole  sys- 
tem in  a great  measure  supported. 

Before  menstruation  commences,  there  is  a preceding  indis- 
position, and  symptoms  indicating  a constitutional  affection. 
And  these  complaints  are  usually  more  severe  in  the  first,  than 
in  the  subsequent  periods.  The  general  revolution  in  the  sys- 
tem begins  to  accumulate  its  action  towards  the  womb,  and 


152 


OF  THE  WOMB. 


those  symptoms  usually  accompanying  uterine  irritation,  show 
how  far  it  is  affected,  and  in  a little  time  the  menses  flow. 
Now,  I conceive,  the  flow  of  the  menstrual  blood,  to  be  not 
the  end  which  nature  is  here  labouring  to  accomplish,  but  the 
means  of  allaying  the  excited  state  of  the  uterine  system  after 
the  object  is  accomplished.  It  is  not  the  discharge  of  a few 
ounces  of  blood  which  relieves  the  system  ; for  drawing  blood 
simply  will  not  do  it  ; but  it  is  the  excited  action  of  the  uterine 
system  which  relieves  the  general  distress,  and  that  topical 
action  has  full  relief  in  the  menstrual  discharge.  General  and 
topical  plethora  are  terms  which  have  been  of  great  service  in 
explaining  this  periodical  change  in  the  female  system,  but  the 
state  of  mere  fulness,  has  little  effect  either  on  the  constitu- 
tional or  topical  change.  Even  in  the  exhausted  and  debilitated 
state  of  the  system,  when  menstruation  ceases  from  the  want 
of  energy  and  power  in  the  vascular  system,  still  there  remain 
the  same  laws  governing  the  sympathies,  and  relations  of  the 
several  parts  ; and  although  they  are  feebly  and  imperfectly 
excited,  they  give  rise  to  accumulated  distress  at  the  period  in 
which  the  menses  should  flow. 

There  is  more  general  distress  at  puberty,  and  when  the 
menses  first  flow  ; but  afterwards,  when  the  periodical  action 
and  discharge  is  established,  there  is  little  or  no  previous  in- 
disposition. 

With  regard  to  vicarious  haemorrhagy  from  remote  parts  of 
the  body,  some,  whose  opinion  I greatly  value,  do  not  con- 
sider them  as  deviations  of  the  menses.  At  all  events,  from 
what  I have  seen  of  such  hsemorrhagies  (tumours,  for  exam- 
ple, discharging  blood  at  the  menstrual  periods,)  I would  ob- 
serve, that  there  is  an  excitement,  throbbing,  and  distention, 
previous  to  the  discharge  of  blood,  which  confirms  me  in  the 
notion  of  the  necessity  of  a counter  excitement  and  action,  as 
well  as  the  discharge  of  blood,  being  necessary  to  make  a 
derivation  from  the  uterine  vessels.  It  is  by  dissection  alone 
that  we  can  form  an  established  opinion  regarding  the  final  use 
of  the  periodical  return  of  the  menses. 

By  dissection  we  come  to  the  knowledge  of  the  most  essen- 
tial facts.  In  the  first  place,  it  is  found,  that  the  ovaria,  and 
their  vessels,  partaking  of  the  general  excitement  of  the 
spermatic  arteries,  are  enlarged,  full  of  blood,  and  with  every 
sign  of  increased  action.  We  find  also,  that  the  ovaria  are 
matured  and  brought  to  pubulate,  and  almost  to  start  from 
their  investing  membranes.  Again,  when  we  attend  to  the 
womb,  we  find,  that  these  are  marks  of  its  whole  vascular 
system  being  roused  to  action.  It  has  become  laxer  in  its 
texture,  and  there  is  a change  similar  to  what  takes  place  itt 


OF  THE  WOMB. 


153 


the  first  stage  of  pregnancy,  but  less  in  degree.  The  vessels 
on  the  inner  surface  of  the  womb  have  been  influenced  by  an 
action  similar  to  inflammation,  and  it  is  asserted,  that  even 
the  decidua  is  sometimes  formed.  Thus,  while  the  ovaria 
are  ripened  to  that  degree  of  maturity,  which  prepares  them 
for  impregnation,  the  surface  of  the  womb,  and  its  whole 
vascular  system,  is  preserved  in  a state  of  preparation  for  the 
adhesion  of  the  ovum,  when  it  shall  have  descended  through 
the  Fallopian  tube.  I conclude  that  in  considering  this  subject 
of  menstruation,  the  mere  circumstance  of  the  discharge  of 
blood  has  been  too  much  attended  to,  while  these  other  more 
essential  circumstances  have  been  neglected. 

It  is  not  easy  to  determine,  says  Haller,  either  in  this,  or  in 
any  other  spontaneous  haemorrhagy,  from  what  kind  of  vessels 
the  blood  flows.  From  the  circumstance  of  the  hsemorrhoidal 
discharge,  which  certainly  is  from  veins,  and  from  the  lochia, 
which  is  generally  supposed  to  be  a discharge  from  the  venous 
sinuses  of  the  wom’b  after  delivery,  we  have  the  argument  of 
analogy,  that  in  menstruation  also  it  is  a venous  discharge. 
This  opinion  is  further  confirmed  from  stagnant  blood  being- 
found  in  the  uterine  veins  of  women  dying  during  the  flow  of 
the  menses,  and  orifices  being  observed  larger  than  could  well 
be  supposed  to  be  the  extremities  of  arteries. 

I would  say,  that  it  is  little  probable  that  spontaneous  hae- 
morrhagy proceeds  from  the  rupture  of  the  extreme  arteries, 
because  it  is  the  activity  of  the  arteries  which  causes  the  hae- 
morrhagy ; and  because  this  activity  is  the  exertion  of  a mus- 
cular force,  and  the  exertion  of  a muscular  fibre  never  is  such 
as  to  tear  the  fibre  itself.  On  the  other  hand,  we  observe  that 
it  is  the  necessary  consequence  of  an  increase  of  the  action  of 
arteries,  that  the  .corresponding  veins  dilate,  and  seem  to  suffer 
a force  of  distention  proportioned  to  their  increased  activity. 
We  must  not  forget  that  many  are  of  opinion,  that  the  men- 
strual blood  flows  from  the  exhaling  arteries.  This  opinion 
must  rest  upon  argument,  and  not  facts,  unless  the  assertion  of 
Raauw  be  taken  as  proof,  that  he  could  distinguish  their 
mouths  ; or  that  of  Mebomius,  who  said  he  introduced 
bristles  into  them.  That  anatomists  have  introduced  bristles 
into  pores,  or  foramina,  it  would  be  ungracious  to  doubt,  but 
that  these  were  the  orifices  of  exhaling  arteries,  is  difficult  to 
believe.  I rather  imagine,  that  there  is  a provision  for  this 
evacuation  in  pores,  or  foramina,  in  the  extreme  veins  on  the 
vascular  inner  surface  of  the  womb. 

From  the  consideration  of  the  cause  of  menstruation,  as  I 
have  conceived  it,  from  the  symptoms  .which  precede  and  ac- 
company it,  and  from  the  effect  attributable  to  the  menstrual 
Vol.  IV.  U 


154 


OF  THE  WOMB. 


action  on  the  uterine  system,  we  cannot  consider  it  as  a mere' 
evacuation  of  blood,  but  rather  as  of  the  nature  of  a critical 
discharge  relieving  the  symptoms  which  preceded  it.  With 
regard  to  the  opinion  of  its  being  a secretion,  we  must  first 
know  accurately  what  is  meant  by  the  term.  If  those  who 
suppose  the  menstrual  blood  a secretion,  mean  only  that  the 
blood  is  occasionally  changed  by  the  action  of  the  vessels  of 
the  womb,  I should  willingly  acquiesce  in  their  opinion,  for 
even  during  the  bleeding  from  the  arm  by  the  lancet,  or  from  a 
common  wound,  the  blood  is  altered  in  the  space  of  the  few 
minutes  during  which  it  flows  ; and  before  the  final  stopping  of 
a common  haemorrhagy,  there  is  a change  in  the  properties  of 
the  effused  blood. 

When  there  is  an  unusual  source  of  irritation  in  the  womb, 
added  to  the  natural  and  periodical  excitement  of  the  parts,  the 
menses  become  more  profuse,  they  last  for  a longer  period, 
the  time  of  their  intermission  is  shortened,  and,  in  the  end, 
from  some  diseases  of  the  womb,  there  is  a perpetual  oozing 
of  blood,  which  debilitates  the  woman,  and  destroys  her  con- 
stitution, or  there  is  sudden  and  profuse  discharge  with  coagula, 
unlike  the  usual  evacuation. 

OF  THE  CHANGE  PRODUCED  BY  THE  UNION  OF  THE  SEXES. 

In  considering  those  changes  produced  on  the  ovaria  and 
womb  by  impregnation,  we  must  have  recourse  to  analogy  in 
the  first  instance.  By  attending  to  the  changes  produced  in 
vegetables,  and  the  lower  animals,  we  maybe  enabled  to  com- 
prehend some  of  the  changes  in  the  female  organs  consequent 
upon  conception,  and  which  we  might  not  otherwise  be  enabled 
to  understand. 

We  see  that  vegetables  propagate  their  branches  in  every 
respect  like  the  parent  trunk.  We  see  in  the  autumn  the  bud 
lodged  in  the  axilla  of  the  leaf,  and  observe  it  pass  through 
the  winter  in  a kind  of  dormant  state  ; but  when  it  is  influenced 
by  the  returning  heat  of  the  spring,  it  shoots  out  to  full  ma- 
turity. This  growth  is  a natural  power  of  propagation,  and 
increase,  marked  by  no  very  peculiar  circumstance,  yet  bearing 
a strong  analogy  to  the  production  of  the  seed. 

In  the  formation  of  the  fruit  of  the  same  tree,  we  see  a 
more  complicated  provision  for  the  propagation  of  the  plant. 
We  find  that  although  the  seed  appears  to  be  formed  by  the 
natural  growth  of  the  part  like  the  bud,  yet  before  it  becomes 
prolific,  and  capable  of  growing,  and  arriving  at  maturity,  it 
must  be  influenced  byr  circumstances  similar  to  the  union  of  the 
sexes  of  animals  ; that  its  power  of  reproduction  depends 


OF  THE  WOMB. 


155 


upon  the  reciprocal  action  betwixt  the  parts  of  the  same  plant, 
or  by  the  approximation  of  male  and  female  plants. 

Between  the  formation,  maturity,  and  impregnation  of  the 
seed  of  plants,  and  those  of  the  ova  of  animals,  there  is  a 
close  analogy.  The  seed  is  formed  and  matured  while  at- 
tached to  the  parent  plant ; but  the  vessels  of  the  plant  having 
completed  this  operation,  shrink  from  their  connections  with 
the  seed,  leaving  it  with  its  little  system  of  vessels  complete, 
and  with  a kind  of  imperfect  life,  which  may  be  considered  as 
analogous  to  a dormant  state.  This  imperfect  life,  or  perhaps 
a state  merely  capable  of  being  excited  into  life  and  motion, 
continues  for  the  winter  season,  or  for  a longer  period. 

The  flower  of  plants  solicits  the  fluids  to  the  seed,  as  the 
influence  of  the  leaf  cherishes  the  bud  in  the  axilla.  The  pulp 
of  the  fruit  is  probably  a provision  of  the  same  kind,  or  when 
it  has  fallen,  to  lay  the  foundation,  by  its  decay,  of  a soil 
suited  to  the  tender  plant. 

In  the  seed  itself,  we  have  much  to  admire.  We  find  it  in- 
cased in  a strong  husk,  or  shell,  which  is  in  general  provided 
with  a porous  part  ready  to  imbibe  the  moisture  of  the  ground. 
In  the  nut  within  the  outer  shell,  there  is  a soft  spongy  sub- 
stance, which,  receiving  the  moisture,  swells  and  bursts  up  the 
shell,  and  relieves  the  seed.  The  kernel  of  the  nut  is  then  like 
a common  seed,  it  has  begun  to  vegetate,  and  these  are  the 
parts  which  form  the  system  of  its  osconomy.  The  principal 
part  of  the  seed  consists  of  albuminous  matter  for  the  supply 
of  the  nourishment  to  the  embryo  plant,  so  as  to  prolong  its 
shoots,  and  to  send  down  its  roots  into  the  earth.  The  little 
embryo  plant  lies  complete  in  all  its  parts,  betwixt  the  Ibbes  of 
albuminous  matter,  in  a state  of  torpor,  or  in  which  the  opera- 
tion of  the  living  principle  is  suspended.  From  the  embryo 
plant  there  extends  into  the  albuminous  matter  of  the  seed- 
vessels,  or  tubes,  inactive,  but  ready  on  the  supply  of  heat  and 
moisture,  to  absorb  the  nutritious  matter  of  the  albumen,  and 
minister  to  the  increase  of  the  embryo  plant. 

Now  the  root  of  the  little  plant  sprouts  from  the  seed,  and 
has  a tendency  to  strike  into  the  ground,  and  the  bud  rises  to 
the  surface  towards  the  light,  and  the  influence  of  the  atmos- 
phere. 

We  see  in  this  instance,  that  the  operation  of  the  system  of 
tubes  of  the  embryo  plant  in  the  albumen  was  merely  sus- 
pended, that  upon  the  seed  being  put  into  the  ground,  the  heat 
and  moisture  promote  the  germination,  by  driving  the  nutriti- 
ous matter  of  the  albumens  to  the  embryo  plant.  In  the  first 
stage  of  this  change,  the  matter  absorbed  by  the  vessels  of  the 
albumen  supply  that  nourishment,  which  afterwards  is  con- 


156 


OF  THE  WOMB. 


veyed  from  the  root  striking  into  the  earth,  and  from  the  leaves 
absorbing  from  the  atmosphere.  And  when  the  roots  have 
struck  into  the  earth,  and  the  first  leaves  rise  upon  the  surface, 
the  lobes  of  the  albumen  are  exhausted  and  fade,  or  rise  up  in 
form  of  leaves,  still  cherishing  the  tender  plant. 

When  we  come  accurately  to  examine  the  situation  of  the 
embryo  in  oviparous  animals,  we  shall  find  the  same  provision 
for  the  nourishment  and  growth  of  the  young  animals,  inde- 
pendent of  external  circumstances,  nourishment  prepared  for 
it  until  it  shall  be  enabled  to  gain  strength  to  feed  itself. 

The  manner  in  which  an  egg  is  formed  is  this  : The  yolk, 
with  its  delicate  membranes,  are  formed  in  the  ovarium  of  the 
hen.  The  ovarium  is  placed  on  the  back-bone,  innumerable 
yolks  are  seen  gradually  formed,  and  successively  increasing 
in  size.  When  they  are  matured,  they  are  of  the  full  size  we 
see  them  in  the  perfect  egg  ; they  are  surrounded  with  a deli- 
cate web  of  membranes,  extremely  vascular,  which  bursts 
when  they  are  mature  and  impregnated,  and  then  they  fall  into, 
or  are  grasped  by  the  infundibulum,  or  what  answers  to  the 
Fallopian  tubes  in  woman  and  quadrupeds.  While  yet  in  the 
egg-bed,  the  cicatricula,  or  embryo,  is  seen  to  be  included  in 
its  membranes,  upon  the  surface,  or  in  the  membrane  of  the 
yolk  ; as  the  yolk,  and  the  imbibed  cicatricula,  passes  through 
the  uterus,  the  yolk,  in  a most  curious  way,  has  the  addition 
of  the  other  part  of  the  egg.  The  uterus  of  a bird  is  not  like 
that  of  other  quadrupeds  or  viviparous  animals,  simply  for 
the  reception  of  the  ovum  ; but  it  is  long  and  convoluted  like 
the  intestines.  And  the  yolk,  as  it  drops  into  the  upper  part 
of  it,  ‘collects  as  it  passes  along  the  uterus,  the  white  of  the 
egg,  which  is  a secretion  from  it.  As  it  proceeds  downwards, 
it  receives  the  membranes  of  the  white,  and  before  it  is  ex- 
cluded, it  is  coated  with  the  shell  to  preserve  it  from  injury 
when  it  shall  be  dropt  from  the  hen.  In  the  fully  formed  and 
incubated  egg  this  is  the  situation  of  the  parts.  Under  the 
shell  is  a membrane  which  invests  the  whole  parts,  but  leaves 
a space  containing  air  in  the  greater  end  betwixt  it  and  the 
shell.  Within  this  membrane  the  glairy  white  of  the  egg  is 
contained,  and  within  the  white  or  albuminous  matter  is  the 
yolk.  Under  the  membrane  of  the  yolk,  there  is  a small  spot 
of  a lighter  yellow  than  the  yolk.  This,  upon  examination  is 
lound  to  be  a vesicle,  and  within  it  we  see  a lesser  circle 
formed  by  an  inner  vesicle  : this  is  cicatricula,  and  within 
this  the  rudiments  of  the  chick  are  contained.  We  may  ob- 
serve, that  the  yolk  js  specifically  lighter  than  the  white  ; 
again,  it  is  fixed,  towards  the  two  extremities  of  the  egg  to 
'the  albumen,  or  white,  by  the  chalaza.  These  are  like  twisted 


OF  THE  WOMB. 


1 57 


cords,  which  arise  from  the  yolk,  and  expand  in  the  white,  so 
that  they  take  a pretty  firm  hold  on  its  tenacious  substance. 
These  chalaza  are  not  fixed  to  the  yolk  in  iis  axis,  but  to  the 
side,  so  that  the  buoyancy  of  the  yolk  keeps  it  revolving  as  the 
egg  is  turned,  so  as  always  to  present  the  cicatricula  to  the 
upper  part  of  the  egg,  in  whatever  way  it  is  placed  ; conse- 
quently it  is  always  contiguous  to  the  body  of  the  hen,  so  as 
immediately  to  receive  the  influence  of  the  maternal  heat. 
By  incubation,  the  principle  of  life  in  the  chick  and  its  mem- 
branes is  roused,  and  the  first  perceptible  change  appears  in 
little  bloody  streaks,  which,  running  together,  form  a circle  of 
vessels,  and  which  are  seen  to  terminate  in  the  umbilicus  of 
the  chick. 

This  vascular  circle,  the  most  beautiful  appearance  of  any 
in  the  ceconomy  of  animals,  ought  to  be  particularly  explained. 
In  Mr.  Hunter’s  book  treating  of  the  blood,  there  is  a plate 
which  represents  the  embryo  of  the  chick  in  the  incubated  eg^;, 
at  three  different  stages  of  its  formation,  beginning  with  the 
earliest  visible  appearance  of  distinct  organization. — The  pre- 
parations from  which  these  figures  are  taken,  form  part  of  a 
complete  series  contained  in  Mr.  Hunter’s  collection  of  com- 
parative anatomy. — They  are  meant  to  illustrate  two  positions 
laid  down  in  his  work,  viz.  that  the  blood  is  formed  before  the 
vessels,  and  when  coagulated,  the  vessels  appear  to  rise  ; that 
when  new  vessels  are  produced  in  a part  they  are  not  always 
elongations  from  the  original  ones,  but  vessels  newly  formed, 
which  afterwards  open  a communication  with  the  original. 

This  to  me  seems  an  idea  founded  on  a very  limited  view  of 
the  state  of  the  parts.  We  must  recollect  that  this  is  not  the 
formation  of  new  parts  or  new  vessels.  The  embrvo  is  in  that 
state  of  which  I have  endeavoured  to  convey  an  idea,  by  the 
term  dormant ; possessing  that  degree  of  life  which  is  to  be 
renewed  by  incubation,  or  artificial  heat,  but  which  will  last  a 
great  length  of  time,  and,  like  the  germ  in  plants,  be  brought 
to  vegetate  only  in  particular  circumstances.  The  tract  of 
these  vessels  is  laid  in  the  original  conformation  of  the  embryo 
and  surrounding  membranes,  they  are  now  merely  called  into 
action,  and  we  see  only  the  effect  of  this  action.  We  see  red 
blood  formed  ; we  know  that  the  redness  of  the  blood  is 
derived  from  the  membranes,  and  matter  which  surround  the 
embryo,  and  that  it  is  conveyed  to  the  chick  or  embryo.  Be- 
fore we  allow  ourselves  to  conjecture  what  is  the  first  motion 
in  the  circle  of  actions  which  now  take  place,  we  must  consider 
whether  it  be  not  more  likely  that  the  first  action  of  these  ves- 
sels is  an  absorption  ; that  is,  an  absorption  in  the  extremities  of 
these  vessels,  or  is  there  first,  an  action  of  the  heart  of  the 


158 


OS  THE  WOMB. 


chick? — We  are  left  to  this  question,  Is  it  probable  that  a 
change  shall  take  place  in  the  fluids  which  shall  stimulate  the 
vessels  ? or  shall  the  heat  of  incubation  stimulate  the  vessels  to 
act  upon  the  contained  fluids  ? or,  as  seems  most  probable, 
does  the  incubation,  at  the  same  time,  produce  a change  in  the 
fluids,  and  stimulate  the  vessels  to  action  ? To  explain  what  I 
should  rather  conceive  to  take  place,  I shall  describe  the  pro- 
bable series  of  actions. 

In  common  seed,  the  small  germ  of  the  plant  has  its  vessels 
passing  out  into  the  lobes  of  the  albumen  to  absorb  the  food, 
upon  the  existence  of  the  peculiar  circumstances  necessary  to 
its  being  stimulated  to  activity  and  growth.  We  have  to  ob- 
serve, that  where  the  nut  was  attached  in  its  husk  to  the  tree, 
it  has  left  a porous  part  ; by  this  cribriform  kind  of  plate  the 
moisture  of  the  earth  enters  ; — that  dry  scurfy  substance  which 
we  observe  on  the  inside  of  the  shell,  swells  with  the  moisture 
tiPhich  also  penetrates  the  albumen  or  kernel — the  moisture 
forming  combination  when  the  albumen  prepares  it  for  absorp- 
tion ; the  vessels  are,  at  the  same  time,  excited,  absorb,  and 
thus  nutritious  fluids  are  conveyed  to  the  germ — the  nut  splits 
by  the  swelling  of  the  parts,  and  the  corculum  or  bud  sprouts 
up.  We  find  then,  that  in  this  instance  the  grain,  or  nut,  is 
brought  into  action  by  the  fluids  absorbed,  forming  new  com- 
binations with  the  albumen  or  kernel,  and  the  active  exertion 
of  the  living  powers,  beginning  by  an  operation  in  the  fluids. 

In  the  same  manner,  I conceive,  that  the  incubation  of  the 
egg  causes  an  action  first  in  the  fluids,  not  in  the  solids  (for 
these  are  solids  according  to  the  strictest  signification  of  the 
term  ; and  strong  membranes,  as  a little  vinegar  will  show, 
when  poured  upon  the  albuminous  substance  of  the  egg.)  A 
change  takes  place  in  the  fluids,  there  are  new  arrangements 
suiting  them  for  absorption,  by  those  circles  of  vessels  which 
are  laid  on  the  original  formation  of  the  membrane.  The 
fluids  act  as  a stimulus  to  those  vessels,  whose  alternate  action 
and  relaxation  never  cease  until  the  termination  of  life.  I con- 
ceive this  explanation,  which  I have  offered,  to  be  more  con- 
sonant with  the  great  principles  of  physiology,  and  an  exten- 
sive analogy  of  similar  actions  in  the  ceconomy,  than  that  ex- 
planation of  Mr.  Hunter,  which  supposes  the  specks  seen  at 
the  sides  of  the  vessels,  to  be  spots  of  coagulated  blood, 
destined  afterwards  to  become  blood-vessels.  For,  I am  apt 
to  conceive,  the  red  blood  to  be  formed  only  after  several 
rounds  of  the  circulation,  and  to  depend  upon  a more  perfect 
assimilation  than  that  first  excited  : and  that  Mr.  Hunter  is  all 
along  in  this  mistake,  that  he  is  supposing  these  vessels  to  be 
newly  formed,  which  are  laid  in  the  constitution  of  the  mem- 


OF  THE  WOMB. 


159 


branes  surrounding  the  embryo,  and  which  are  now  only  called 
into  action,  and  only  become  apparent  when  they  convey  red 
blood. 

In  the  system  of  the  egg  there  are  other  circumstances  wor- 
thy of  notice  : as  the  chick  grows  by  the  absorption  of  the 
white,  or  albumen,  the  new  combinations  reduce  to  a lesser 
bulk  the  whole  mass,  which  is  within  the  shell,  and  now  we 
perceive  the  use  of  the  air  cell,  which  enlarging,  fills  up  this 
space.  When  the  chick  has  escaped  from  the  shell,  the  yolk 
of  the  egg  is  not  exhausted,  but  it  is  found  to  be  received  into 
the  belly  of  the  chicken,  and  to  have  a conduit  leading  into  the 
duodenum,  by  which  it  is  poured  into  the  intestinal  canal.  It 
is  for  some  time  a source  of  supply  to  the  young  animal  until 
its  strength  is  equal  to  the  digestion  of  its  appropriate  food. 
And  in  this  respect  it  is  analogous  to  the  suckling  of  viviparous 
animals. 

Let  us  now  observe  what  analogy  exists  betwixt  the  genera- 
tion, or  rather  the  birth  and  nourishment  of  the  embryo  of  the 
viviparous  animal,  and  those  of  the  oviparous.  As  to  the  pre- 
cise effect  which  the  approach  of  the  male  has  upon  the  ovari- 
um of  the  female,  whether  by  this  union  of  the  sexes,  there  is 
an  actual  addition  to  the  ovum,  or  only  an  influence  exerted  on 
the  parts  already  there,  by  the  presence  of  the  male  semen,  it 
seems  almost  needless  to  hope  for  an  absolute  decision. 

The  resemblance  of  the  offspring  to  both  parents,  would  in- 
fluence us  at  once  to  conclude,  that  there  must  be  a union  of 
the  parts  from  both  sexes.  But  when  we  consider  how  ipuch 
the  peculiarities  of  individual  animals  depend  upon  certain  pe- 
culiarities of  action  ; how  the  constitutional  predispositions 
must  depend  on  the  same  peculiarities  in  the  action  of  parts, 
since  the  doctrine  of  absorption  teaches  us,  that  of  actual  sub- 
stance nothing  is  permanent,  but  all  suffers  an  incessant  revolu- 
tion and  change,  of  which  nothing  can  remain  but  certain  pe- 
culiarities of  action  ; we  may  then  come  to  allow,  that  the  male 
semen  merely  influences  the  state  of  the  parts  already  formed, 
and  does  not  bestow  an  actual  substance. 

In  the  speculations  on  the  subject  of  generation,  facts  and 
observations  have  been  so  very  rarely  attended  to,  that  those 
which  have  been  offered  seem  to  have  had  a preponderance 
much  beyond  their  real  value.  Thus  the  microscopical  de- 
monstration of  animalculse  swimming  in  the  semen  of  the  male, 
has  given  birth  to  an  idea  that  they  were  homunculi,  which  be- 
ing introduced  into  the  proper  nidus  of  the  female,  grew  up  to 
man’s  estate.  Though,  where  all  is  conjecture,  and,  perhaps, 
as  no  better  explanation  is  to  be  offered,  it  may  seem  improper 
so  directly  to  contradict  any  theory,  still  I must  say,  that  this  is, 


160 


OF  THE  WOMB. 


in  my  mind,  the  height  of  absurdity.  To  suppose  an  animal 
secreted  along  with  the  seminal  fluid  from  the  testicle  of  the 
male  (and  which,  in  all  probability,  is  the  production  of  stag- 
nation and  putridity,)  to  swim  and  be  nourished  in  the  male 
semen,  and  yet  to  hold  that  on  being  introduced  into  the  ovaria, 
it  changes  from  an  active  animal  into  an  impalpable  gelatinous- 
like  mass,  and,  after  a series  of  changes,  grows  at  last  to  the 
maturity  of  a human  being,  is  altogether  beyond  my  compre- 
hension. 

The  experiments  made  by  the  ingenious  Dr.  Heighton, 
throw  considerable  light  upon  these  delusive  speculations  re- 
garding the  impregnation  of  the  female.  He  found  by  experi- 
ments on  rabbits,  that  upon  cutting  the  Fallopian  tubes,  forty- 
eight  hours  after  the  coitus,  the  impregnation  was  equally  ob- 
structed as  when  he  had  cut  them  previous  to  admitting  the 
male  ; it  would  appear  that  in  these  animals  impregnation  is  by 
no  means  the  instantaneous  effect  of  the  union  of  the  male  and 
female,  but  that  it  requires  at  least  fifty  hours  ; for,  when  Dr. 
Heighton  cut  the  Fallopian  tubes  at  that  period,  it  did  not  pre- 
vent impregnation.  Dr.  Heighton  proves,  that  the  generative 
process  is  not  an  instantaneous  effect,  as  we  should  very  natu- 
rally suppose,  but  an  operation  requiring  time.  That  the  se- 
men does  not  reach  the  ovaria  during,  or  immediately  after  the 
coitus,  is  sufficiently  evident ; and  it  is  still  more  so,  that  the 
ovum  is  impregnated  while  in  the  ovarium,  and  not  upon  its 
descent  into  the  womb,  which  is  proved  from  the  foetus  some- 
times remaining  in  the  ovarium,  or  tubes,  and  growing  to  ma- 
turity. Dr.  Heighton  supposes  the  semen  only  to  affect  the 
vagina  and  uterus,  and  that  a consent  of  parts,  or  sympathy,  is 
communicated  along  the  tubes  and  ovary  to  the  ovum ; and 
that  neither  the  semen,  nor  the  aura  seminalis  reaches  the  ova- 
ria. When  we  look  abroad  for  analogies,  however,  and  find 
the  semen  of  some  animals,  as  fishes,  merely  thrown  out  upon 
the  already  evacuated  spawn,  we  cannot  readily  acquiesce  in 
this  opinion  of  the  mere  sympathy  of  the  female  parts  calling 
the  young  animal  into  life. 

Leaving  this  subject,  we  have  to  observe,  that  previous  to 
impregnation  there  is  a ripeness  and  prominence  of  some  of 
the  ova,  that  by  coition  the  Fallopian  tubes  do  not  instantly 
grasp,  impregnate,  and  cause  the  bursting  of  the  ovum  from 
the  ovarium  ; but  there  is  an  action  commenced  which  gradu- 
ally brings  about  this  change.  Whilst  the  ovary  is  thus  affect- 
ed, the  tubes  are  preparing  for  their  action  of  embracing  the 
ovum,  there  is  an  increased  turgescence  in  their  vessels,  and  an 
enlargement  and  swelling  of  the  fimbriated  extremity.  When 


OF  THE  WOMB. 


161 


thus  prepared,  it  approaches  the  ovarium,  grasps,  and  receives 
the  ovum,  and  by  a peristaltic  motion,  probably  very  slow  and 
gradual,  the  ovum  is  conveyed  into  the  cavity  of  the  uterus. 


OF  THE  OVUM,  AND  ITS  CONNECTIONS  WITH  THE  UTERUS 
IN  THE  EARLY  MONTHS  OF  PREGNANCY. 

The  ovum,  when  it  has  descended  into  the  uterus,  and  is 
perfect  in  its  structure,  is  a soft  oval  mass,  fringed  with  vessels, 
and  composed  of  membranes  containing  the  early  fetus. 
When  opened,  or  dissected,  it  presents  three  cavities,  or  we 
observe  the  fetus  to  be  surrounded  with  three  distinct  mem- 
branes. 1.  Decidua,  or  tunica  filamentosa,  false  chorion,  or 
spongy  chorion.  2.  The  chorion.  3.  The  amnios.  Of  these 
coats,  the  outer  one  is  formed  by  the  womb,  the  others  consti- 
tute the  ovum  as  it  has  descended  from  the  ovarium.  We 
shall,  in  the  first  place,  attend  to  the  original  membranes  and 
general  constitution  of  the  ovum,  and  then  to  the  deciduous 
covering  which  it  receives  in  the  womb. 

Plan  of  the  Membranes. 


\ 

\ 

A,  The  Fcetus.  B,  The  Amnios.  C,  The  Chorion.  D, 
' 11  The  Vesicula  Alba. 

Amnion.  The  amnion  is  the  vesicle  which  immediately  in- 
volves -the' fetus.  It  is  a very  thin  and  pellucid  membrane  in 
the  early  stage  of  pregnancy,  but  it  acquires  considerable  thick- 
ness and  strength  in  the  latter  months. 

The  amnion  contains  a thin  watery  fluid  in  which  the  fetus 
is  suspended.  In  the  abortion  of  the  earlv  months,  we  find  the 
quantity  of  this  fluid  very  great  in  proportion  to  the  whole 

Vol.  iv.  ' X 


262 


OF  THE  WOMB. 


ovum,  and  this  forms  a defence  to  the  delicate,  and  almost  ge- 
latinous substance  of  the  fcetus,  while  it  is  a provision  also  tor 
the  regular  presentation  or  the  head  of  the  child,  for  now  the 
fcetus  being  suspended  in  this  fluid,  and  hanging  bv  the  umbili- 
cus, and  the  head  and  upper  part  of  the  body  greatly  prepon- 
derating, it  takes  that  position  with  the  head  presenting  to  the 
orifice  of  the  womb  which  is  necessary  to  natural  and  safe  la- 
bour, the  fcetus  being  prevented  from  shifting  in  the  latter 
months  by  the  closer  embracing  of  the  child  by  the  uterus. 

Chorion.  The  chorion  is  the  second  involving  membrane 
of  the  fcetus ; on  the  inside  it  is  smooth,  and  betwixt  it  and  the 
amnion  a gelatinous  fluid  is  interposed.  In  the  early  months 
it  is  much  stronger  than  the  amnios,  but  in  the  advanced  stage 
it  has  come  in  contact  with  the  amnios,  no  fluid  being  betwixt 
them.  And  in  proportion  as  the  amnios  gains  strength  to  be 
of  essential  service  in  dilating  the  orifice  of  the  womb  during 
labour,  the  chorion  has  relatively  become  very  thin  and  weak. 
On  the  outside  the  chorion  is  shaggy  and  vascular,  and  consti- 
tutes those  minute  extremities  of  the  vascular  system  of  the 
ovum,  which  attach  to  the  surface  of  the  womb,  or  rather  to 
the  flocculent  membrane  which  it  throws  out. 

The  umbilical  chord.  When  we  can  first  discern  the 
fcetus,  it  is  merely  like  an  opaque  oval  body  of  the  size  of  a 
common  fly,  and  closely  attached  to  the  amnion  ; but,  by  de- 
grees, it  recedes  from  it,  and  then  we  perceive  that  it  is  attach- 
ed by  the  umbilical  chord,  which  consists  of  the  trunk  of  the  ves- 
sels going  out  from  the  foetus,  and  which  distributed  upon  the 
chorion  receive  the  supplies  from  the  maternal  system. 

Now  we  perceive  that  the  fcetal  system  which  descends  from 
the  ovarium,  is  not  merely  a foetus  or  embryo,  but  that  this  em- 
bryo, besides  a system  of  vessels  within  its  own  body,  is  sur- 
rounded completely  with  membranes,  and  that  from  the  vascu- 
lar system  of  the  embryo,  there  go  out  vessels,  which  being  mi- 
nutely distributed  to  the  outer  vesicle,  or  membrane,  and  actu- 
ated by  the  same  heart  which  circulates  the  blood  through  it, 
our  little  corporal  system  prepares  for  imbibing  the  due  nour- 
ishment from  the  uterus. 

Vesicula  alba.  The  vesicula  alba,  or  umbilicalis,  is  a 
little  vesicle  which  lies  betwixt  the  chorion  and  amnion  ; it  con- 
tains a white  fluid  ; it  is  connected  with  the  navel  or  chord,  by 
an  artery  and  vein.  Very  little  has  been  offered  as  explanatory 
of  its  use,  it  has  been  considered  as  similar  to  the  alantois  of 
quadrupeds,  and  having  a connection  with  the  urachus  ; but  it 
has  no  communication  with  the  bladder,  and  soon  disappears. 
Whereas,  if  it  had  been  for  receiving  the  secretion  of  urine,  it 
would  have  been,  prepared  for  the  more  mature  sta  te  of  the  fcetus , 


OF  THE  WOMB. 


163 


I conceive  it  not  to  be  improbable,  that  it  is  a provision  of 
supply  for  the  embryo,  previous  to  its  perfect  attachment  to  the 
uterine  system,  and  during  its  descent  into  the  womb,  perhaps 
similar  to  the  albumen  of  oviparous  animals,  but  which,  after 
the  perfect  establishment  of  the  connection  betwixt  the  fcetal 
and  maternal  system,  shrinks  and  disappears,  as  being  no  lon- 
ger necessary. 

OF  THE  ADDITIONAL  MEMBRANES  WHICH  THE  OVUM  RE- 
CEIVES FROM  THE  UTERUS. 

While  the  ovum  is  taking  the  changes  consequent  upon 
impregnation,  the  womb  partaking  of  the  general  sympathy 
which  prevails  over  the  whole  uterine  system,  takes  a change 
adapting  it  for  its  reception.  The  first  appearance  of  action  is 
marked  by  a greater  activity  of  the  vessels,  a swelling  and  soft- 
ness of  its  substance.  While  on  the  inner  surface  there  is  an 
exudation  which  being  converted  into  a spongy  membrane,  is 
peculiarly  adapted  for  the  reception  and  adhesion  of  the  ragged 
and  vascular  surface  of  the  ovum. 


In  this  plan  we  shall  be  able  to  observe  the  relations  and  in- 
flections of  the  uterine  membranes  or  decidua,  as  seen  and  de  • 


164} 


OF  THE  WOMB* 


scribed  by  Dr.  Hunter,  and  of  their  correctness,  my  observa- 
tions in  dissection  leave  no  doubt  in  my  mind.  AA,  The 
uterus  in  outline  ; B,  the  amnion  with  the  foetus  ; C,  the 
chorion.  Now  it  is  observed,  upon  a careful  examination  of 
an  abortion  of  the  early  months,  that  besides  the  chorion  and 
amnion,  there  is  a spongy  membrane  of  two  distinct  lamina 
which  invests  the  chorion.  The  outermost  of  these  is  found 
to  surround  the  whole  ovum,  even  investing  that  part  which 
has  become  the  placenta  by  the  accumulation  of  vessels.  This 
outer  membrane  then  may  be  represented  by  the  line  DD.  It 
is  represented  as  adhering  to  the  surface  of  the  womb,  as  it 
must  do  in  fact.  We  observe  again,  that  it  is  perforated 
where  the  Fallopian  tube  enters  the  womb,  that  at  this  part  it 
is  not  formed  ; so  that,  according  to  Dr.  Hunter,  and  the  pre- 
parations which  I possess,  these  tubes  open  into  its  inside. 

Upon  dissecting  up  the  outer  lamina  of  the  decidua,  we  find 
that  where  the  placenta  commences,  it  is  reflected  over  the 
surface  of  the  ovum  and  the  shaggy  chorion  of  the  ovum,  so  as 
to  be  represented  by  the  letters  EE.  We  shall  now  understand 
the  distinction  betwixt  the  Decidua  Vera  DD,  and  the_De- 
cidua  Rejlexa  EE. 

It  would  appear  that  this  membrane  is  either  completely 
formed,  or  at  least  the  fluid  which  is  to  form  it,  is  thrown  out 
previous  to  the  descent  of  the  ovum  ; indeed,  so  intimate  is 
the  Sympathy  betwixt  the  whole  uterine  system,  that  this  mem- 
brane is  formed  in  those  cases  where  the  ovum  does  not  de- 
scend, but  constitutes  the  extra  uterine  conception. 


Dr.  Hunter  supposed,  that  the  ovum  passed  into  the  cavity 
of  the  uterus  whilst  the  coagulable  lymph  was  pouring  out  by 
the  arteries  of  the  uterus,  and  that  it  was  thus  immersed  in, 
and  surrounded  by  the  decidua,  for  he  could  not  conceive  that 


OF  THE  WOMB, 


165 


it  could  gain  admission  betwixt  the  lamina  of  the  membrane 
already  formed. 

I should  conceive  that  the  ovum  A,  upon  its  descent  gets  in- 
tangled  behind  the  deciduous  membrane  B,  by  which  means 
the  ovum  is  not  left  loose  in  the  cavity  of  the  womb,  but  is 
soon  attached  and  surrounded  with  a membrane,  or  vascular 
web,  from  which  it  can  immediately  draw  supplies,  and  by 
this  provision  also  its  adhesion  to  the  superior  part  of  the 
uterus  is  insured.  But  as  the  same  action  of  the  uterus  con- 
tinues, and,  as  we  must  naturally  suppose,  be  rather  occa- 
sioned by  the  presence  of  the  ovum  in  its  cavity,  the  surface  of 
the  uterus  at  A continues  to  throw  out  a coagulable  matter 
which  surrounds  that  part  of  the  ovum,  so  that  this  will  im- 
mediately become  its  situation. 


A,  The  Decidua  Vera , formed  before  the  descent  of  the 
ovum.  B,  the  Decidua  Reflex  a,  formed  by  the  ovum  getting 
behind  it,  and  pushing  it  down.  C,  the  efflorescence  which 
continued  to  be  poured  out,  surrounds  the  upper  part  of  the 
ovum,  and  which,  from  its  more  immediate  supply  from  the 
uterus,  will  in  time  form  the  sole  support  of  the  foetus,  viz., 
the  uterine  portion  of  the  placenta. 

Of  the  placenta,  and  of  the  nutrition  of  the  fcetus. 

When  the  ovum  first  descends  into  the  uterus,  the  fleecy 
surface  of  the  chorion  establishes  a universal  adhesion,  but  no 
sooner  is  the  attachment  of  the  ovum  established,  than  the 
vessels  of  the  fcetus  which  are  universally  distributed  over  its 
surface,  begin  to  accumulate  to  that  point  from  which  the  more 
abundant  supply  is  obtained.  Thus,  from  the  universal  adhe- 
sion the  vessels  of  the  fcetus  are  massed  and  accumulated  tor 


166 


OF  THE  WOMB. 


gether,  so  as  to  form  a thick  cake  or  placenta.  This  takes 
place  upon  the  same  principle  that  the  roots  of  a plant  stretch 
towards  the  soil  best  suited  to  it,  or  the  branches  and  leaves  of 
a plant  grow  and  spread  towards  the  light.  The  placenta  is 
destined  to  adhere  to  the  fundus  of  the  womb,  and  there  we 
observe  the  accumulation  of  the  large  vessels  of  the  womb,  it 
being  equidistant  from  the  several  sources  of  blood  ; and  to 
this  point  is  the  tendency  of  the  vessels  of  the  chorion  so 
great,  that  we  sometimes  see  the  vessels  of  the  chord  running 
three  or  four  inches  upon  the  membranes  before  they  reach  the 
placenta,  evidently  shewing  that  the  point  to  which  the  umbili- 
cal chord  had  been  originally  attached,  was  not  opposite  to  the 
more  vascular  part  of  the  womb  ; but  that  the  vessels  had  to 
stretch  and  elongate  some  way  from  the  insertion  before  they 
accumulate  in  form  of  the  placenta,  towards  that  part  of  the 
uterus  where  there  was  the  greater  vascularity. 

But  the  formation  of  the  placenta  on  the  fundus  of  the 
womb  is  not  constant,  although  there  are  many  provisions  for 
ensuring  attachment  there.  But  when  it  does  form  low  in  the 
womb,  or  on  the  orifice  itself,  we  thert  perceive  the  reason  of 
nature’s  solicitous  care  in  preventing  it ; for  it  occasions  the 
most  dangerous  floodings  from  the  placenta  presenting  on  the 
approach  of  labour,  and  its  connections  being  necessarily  torn 
up  previous  to  the  delivery  of  the  child. 

The  placenta  of  the  advanced  stage  of  gestation  is  a mass 
formed  partly  by  the  accumulations  of  the  vessels  of  the  fetus 
(the  trunk  of  which  is  the  umbilical  chord,)  and  partly  of  a 
vascular  and  cellular  portion  formed  by  the  uterus.  On  the 
surface  attached  to  the  womb,  the  placenta  exhibits  deep  and 
irregular  fissures  which  divide  it  into  lobes  ; but  on  the  inner 
surface  is  smooth  from  the  investing  membranes,  but  raised 
into  irregularities  by  the  numerous  and  tortuous  ramifications 
of  the  umbilical  vessels.  When  rudely  torn  or  cut  into,  it  ap- 
pears to  be  a spongy  substance,  formed  in  a great  part  of  an 
irregular  tissue  of  vessels. 

In  the  human  subject  we  find,  that  the  maternal  part  of  the 
placenta  is  thrown  off  with  the  other  secundines,  and  does  not 
separate  from  the  festal  part  of  it.  While,  in  other  viviparous 
animals,  the  monkey  excepted,  the  filamentous  extremities  of 
the  fcetal  vessels  separate  from  the  glandular  mass  formed  by 
the  maternal  vessels  of  the  uterus. 

The  placentary  vessels  of  the  feetus  never  touch  the  surface 
of  the  womb,  but  communicate  with  the  maternal  system 
through  the  vessels  of  the  womb,  which  pierce  the  deciduous 
membrane.  Still  the  question  of  the  precise  manner  in  which 
the  vessels  of  the  fetus  communicate  with  those  of  the  mother 


OF  THE  WOMB. 


167 


remains  undetermined.  I conceive  that  in  the  early  stage  the 
deciduous  membrane  being  thrown  out  by  the  action  of  the 
uterine  vessels,  those  of  the  chorion  stretch  into  it,  and  absorb 
the  nourishment.  The  decidua  is  a vascular  membrane,  but  it 
has,  at  the  same  time,  a peculiar  spongy  texture.  This  spongy, 
or  reticulated  structure  of  lamina  of  the  decidua  ceases  where 
the  placenta  is  affixed.  When  we  carefully  dissect  up  the 
decidua  to  the  margin  of  the  placenta,  it  is  found  to  be  more 
rigid,  white,  firm,  and  thick.*  When  we  examine  the  out- 
side of  an  entire  ovum,  we  observe  that  at  the  place  covering 
the  placenta,  it  is  corrugated  and  full  of  irregular  eminences 
like  the  convolutions  of  the  brain,  and  among  those  irregu- 
larities many  small- convoluted  arteries  may  be  discerned,  with 
spots  of  extravasation  and  the  flat  mouths  of  veins.  Upon 
dissecting  up  this  maternal  part  of  the  placenta,  we  find  it  to 
form  the  firmest  part  of  it  ; and  by  the  difference  of  colour,  as 
well  as  by  the  possibility  of  tearing  it  up,  or  dissecting  from 
the  mass  of  vessels  of  the  chorion,  we  recognize  it  as  the 
decidua.  This  union,  however,  betwixt  the  maternal  and 
foetal  parts  of  the  placenta  is  intimate,  and  it  is  impossible  to 
determine  by  dissection  with  the  knife,  whether  there  be  inos- 
culations betwixt  tjie  maternal  and  foetal  vessels,  or  whether 
the  nourishment  of  the  foetus  is  by  absorption,  nor  can  we  dis- 
tinguish in  the  first  months  the  cellular  intertexture  which  may 
be  observed  in  the  placenta  of  the  full  time,  as  described  by 
Mr.  Hunter. 

In  explanation  of  this  part  of  our  subject,  I have  purposely 
dissected,  and  made  drawings  of  the  ovum  in  several  stages. 
This  point  of  anatomy  relating  to  the  decidua,  is  particularly 
explained  in  Plates  VI.  and  VII.  to  which  I refer  the  reader. 

Of  the  liquor  amnii,  as  conducing  to  the  nourish- 
ment OF  THE  FCETUS. 

Some  physiologists  observing  the  strict  analogy,  which  exists 
between  the  function  of  the  placenta  and  the  lungs  of  breath- 
ing animals,  have  conceived,  that  the  liquor  amnii  is  the  source 
of  nourishment,  and  that  it  is  taken  into  the  stomach.  I be- 
lieve they  have  conceived  some  analogy  to  exist  betwixt  the  al- 
bumen of  the  egg  and  the  liquor  amnii,  which  in  their  minds 
has  strengthened  this  opinion.  But  there  is  here  no  analogy  : 
we  have  seen,  that  the  embryo  of  oviparous  animals  being 
formed  with  the  yolk  in  the  egg-bed  or  ovarium,  descends  into 


T fpeak  after  differing  the  ovtim  of  the  third  month. 


168 


OF  THE  WOMB. 


the  uterus,  and  there  receives  the  addition  of  the  albumen  or 
white.  On  the  other  hand,  we  find  that  the  ovum  of  vivipar- 
ous animals  is  formed  in  the  ovarium  ; and  that  the  liquor 
amnii  being  within  the  membranes  of  the  ovum,  must  be  the 
production  of  the  fetal  system.  Further,  when  the  ovum  has 
descended  into  the  womb,  and  grown  to  some  maturity,  we 
see  that  there  is  no  connection  by  vessels  betwixt  the  fetus  and 
mother  but  through  the  placenta  ; that  the  liquor  amnii  is 
within  the  involving  membranes  of  the  fetus,  and  that  conse- 
quently it  must  be  thrown  out  by  the  vessels  of  the  fetal  sys- 
tem. Thus,  to  suppose  the  fetus  to  be  fed  by  the  liquoT 
amnii,  would  be  to  suppose  it  to  draw  resources  from  its  own 
system,  and  that  the  vessels  poured  out  a fluid,  which  is  after- 
wards to  be  taken  into  the  stomach.^  But  without  adducing 
arguments,  it  is  sufficient  to  say,  that  fetuses  have  been 
brought  forth,  monstrous  in  their  conformation,  and  without 
mouths  yet  well  grown. 

Of  the  placenta  as  the  source  or  nourishment  to 
The  fcetus.  When  we  consider  the  mere  speck  of  the  em- 
bryo in  the  first  weeks,  we  see  that  it  can  have  no  other  source 
of  nourishment  than  through  the  extreme  vessels  of  the 
chorion,  connected  with  the  short  umbilical  chord  ; and  we 
may  be  convinced  also,  that  in  its  progress  to  maturity,  when 
the  general  connections  of  the  chorion  cease,  and  the  placenta 
is  formed,  the  sole  supply  is  through  its  vessels.  Regarding 
the  manner  of  the  communication  betwixt  the  vessels  of  the 
mother  and  child  there  are  many  opinions.  The  simplest  ex- 
planation, but  the  furthest  from  the  truth  is,  that  the  arteries 
of  the  womb  are  continued  into  the  veins  of  the  fetal  portion 
of  the  placenta.  That  on  the  other  hand,  the  arteries  of  the 
fetal  system  are  continued  into,  or  inosculate  with  the  veins  of 
the  womb  ; and  that  thus,  the  blood  of  the  mother’s  system  is 
carried  by  direct  inosculation.  A little  investigation  will  con. 
vince  us,  that  this  is  a very  unlikely  conjecture.  We  see  the 
embryo  surrounded  with  its  vessels,  and  forming  a complete 
system  within  itself,  descend  into  the  womb.  We  see  that  the 
attachment  betwixt  the  surface  of  the  ovum  and  the  womb,  de- 
pends on  a reciprocal  action  betwixt  them  ; and  when  the  fetus 
is  feeble,  or  diseased,  or  when  it  dies,  the  uterus  immediately 
separates  from  it,  as  from  a dead  part,  and  there  is  an  abortion. 
Again,  it  is  not  natural  to  suppose,  that  the  circulating  fluids 
of  the  adult  are  calculated  for  the  circulation  in  the  embryo,  or 

* A greater  abfurdity  than  that  of  which  a foreign  author  is  guilty  cannot  be 
imagined,  becaufe  the  liquoramnii,  or  fome  fluid,  is  found  in  the  trachea,  he  fup- 
pofes  that  the  foetus  refpires,  and  receives  oxigenation  from  the  liquor  amnii. 


OF  THE  WOMB. 


169 


that  the  blood  of  the  adult  is  fit  for  the  circulation  of  the  fetus. 
When  we  inject  the  vessels  of  the  fetus,  we  find  the  veins  and 
arteries  of  the  umbilical  chord  to  inosculate  freely  with  each 
other,  and  the  fluid  passes  from  the  arteries  to  the  veins  with 
little  extravasation  or  escape  of  fluid,  and  such  only  as  may  be 
supposed  to  pass  from  torn  vessels.  Again,  the  bleeding  of 
the  child  does  not  draw  from  the  maternal  system ; for  ex- 
ample, when  the  accoucheur  has  to  perform  the  operation  of 
embryulcia,  and  when  the  arteries  of  the  brain  pour  out  their 
blood,  the  woman  does  not  suffer,  nor  is  there  any  danger  of 
haemorrhagy  from  the  chord  after  the  delivery  of  the  child. 
Again,  what  does  the  analogy  of  other  animals  show  us  ? 
We  may  observe,  in  the  first  place,  that  probably  on  account 
of  the  peculiar  form  of  the  womb  of  woman,  and  in  these  cir- 
cumstances to  guard  her  from  danger  of  haemorrhagy  during 
deliver}',  it  is  necessary  that  the  placenta  should  be  accumulated 
towards  the  fundus  of  th;e  womb.  Now,  to  allow  less  danger 
of  the  separation  of  the  secundines  from  the  womb,  and  con- 
sequent abortion,  there  follows  a necessity  for  the  human  pla- 
centa being  attached  in  a particular  manner  ; and  in  place  of 
the  maternal  part  of  the  placenta  remaining  with  the  womb,  as 
in  other  animals,  the  whole  mass  separates  on  the  delivery  of 
the  child.  The  necessity  for  this  firmer  attachment  of  the 
human  placenta,  causes  the  connection  betwixt  the  fetal  and 
the  maternal  portions  to  be  very  intimate,  and  the  manner  of 
the  vascular  connection  by  no  means  easily  demonstrated. 

In  other  animals,  however,  for  example  in  those  which 
have  the  small  and  numerous  placenta,  or  cotylidones,  the  fetal 
and  maternal  portions  of  the  placenta  separate  easily  ; the  ma- 
ternal part  being  a prominent  vascular  bed,  which  is  a part  of 
the  womb,  and  is  not  deciduous.  Here  we  find,  that  the 
glandular-like  portion  which  belongs  to  the  womb  may  be 
minutely  injected,  and  no  particle  of  colour  pass  into  the  fetal 
part ; and  again  injection  shows  the  fetal  portion  to  be  merely 
composed  of  the  fleecy  extremities  of  vessels,  which,  how- 
ever minutely  injected,  do  not  show  any  inosculations  with  the 
maternal  vessels  ; in  short,  here  the  connection  betwixt  the. 
extremities  of  the  two  systems  is  so  very  loose,  and  the  fila- 
ments so  minute,  and  almost  like  an  impalpable  mucus,  that 
we  can  imagine  no  other  kind  of  connection  than  that  the  ex- 
tremities of  the  umbilical  vessels  take  up  by  absorption  the 
nutritious  matter  necessary  for  the  system  of  the  child,  and 
that  this  is  secreted  by  the  vessels  of  the  womb. 

Investigation’in  every  department  of  natural  history  shows 
a similarity,  and  a simplicity  in  the  operations  of  nature. 
Comparative  anatomv  mav  be  brought  with  much  advantage. 
Voe.  IV.  ' ' Y 


OF  THE  WOMB. 


170 

in  illustration  of  the  very  obscure  laws  which  guide  the  func- 
tions of  the  parts  of  generation.  When  we  turn  our  attention 
to  the  egg,  we  find,  in  the  first  place,  that  the  vascular  system, 
is  complete  within  itself,  and  requires  no  permanent  connec- 
tion with  the  maternal  system  to  invigorate  its  action.  We 
find  that  the  artery  which  passes  out  of  the  umbilical  chord  of 
the  chick,  and  which  is  distributed  to  the  membranes  of  the 
white,  pulsates  strongly,,  and  carries  venous  coloured  blood. 
We  find  the  returning  vein  carrying  arterial  coloured  blood. 
We  find  then  that  these  vessels  must  have  a double  function, 
they  imbibe  the  nourishment  from  the  white,  and  convey  it  to 
the  increase  of  the  chick  ; and  they  at  the  same  time,  perform, 
an  action  similar  to  that  of  the  pulmonary  vessels  of  the  adult, 
seeing  that  they  carry  out  dark-coloured  blood,  and  convey  it 
back  to  the  chick,  of  a bright  vermilion  colour.  Now,  I do 
not  conceive,  that  this  change  upon  the  blood  is  performed  by 
the  communication  with  the  atmosphere  through  the  shell,  for 
I see  no  distinction  in  the  colour  of  the  vessels,  which  are  con- 
tiguous to  the  membrane  of  the  shell,  and  those  which  are  re- 
moved from  it  by  the  expanding  of  the  air-cell.  Further  we 
find,  that  there  is  an  intermediate  kind  of  generation  in  fishes 
which  are  oviparous,  but  retain  the  egg  within  their  womb, 
until  the  foetus  is  matured  ; here  no  communication  with  the 
air  or  water  can  be  allowed. 

Since  we  see  that  the  chick  in  ovo  is  capable  of  ministering 
in  every  essential  particular  to  its  own  increase,  wherefore- 
should  we  suppose  that  the  foetus  of  viviparous  aqimals  has  any 
other  more  particular  connection  with  the  womb  of  the  mo- 
ther ? — The  difference  is,  in  my  mind,  this  simply  ; the  ovum  of 
the  oviparous  animals  descending  through  the  convoluted  and 
intestinal-like  womb  of  the  hen,  accumulates  a quantity  ol 
matter  around  it,  which  serves  every  purpose  of  nutrition 
when  the  embryo  shall  be  finally  separated  from  the  maternal 
system  ; but  in  the  viviparous  animals  the  ovum  descending 
into  the  womb  remains  there,  and  has  an  incessant  supply  of 
nutritious  fluid,  secreted  from  the  vessels  of  the  womb,  as  it 
is  required  by  the  appetenev  of  the  foetal  system.  As  in  the 
egg,  the  membranes  surrounding  the  white  have  the  same 
effect  upon  the  blood,  which  is  afterwards  produced  by  the 
lungs  ; so  has  the  placenta  of  viviparous  animals  the  double 
1 unction  of  supplying  nourishment,  and  the  oxigenation  of 
their  blood.  The  umbilical  vein  carries  back  pure  arterial 
blood,  and  the  common  opinion  is,  that  the  blood  of  the  foetus 
coming  in  contact  with  the  blood  of  the  maternal  system,  re  - 
ceives the  principle  from  it,  which  bestows  this  quantity  of 
colour,  with  other  i^cessary  qualities,  of  which  this  of  colour 


07  THE  WOMB. 


171 


is  but  the  sign  to  our  observation.  It  is  not  necessary  to  this 
change  on  the  foetal  blood,  that  it  should  come  in  immediate 
contact  with  the  maternal  blood,  for  it  is  possible,  nay  probable, 
that  the  matter  thrown  out  by  the  maternal  vessels,  whilst  it  is 
nutritious,  has  also  in  it,  in  a condensed,  and  not  a gaseous 
form,  that  which  is  essential  to  the  change  of  the  blood  of  the 
foetus  from  the  modena  colour  to  bright  vermilion. 

OF  THE  EXTRA  UTERINE  CONCEPTION. 

We  find  some  curious  facts  relating  to  the  action  and  sym- 
pathy amongst  the  parts  of  generation,  proved  by  the  cases  of 
extra  uterine  conception.  When  nature,  balked  and  inter- 
rupted in  her  usual  course  of  operation,  shows  unusual  resour- 
ces, it  would  appear,  that  the  ovum,  after  impregnation,  has  in 
some  cases  remained  attached  to  its  original  seat  in  the  ovari- 
um, perhaps  owing  to  some  want  of  due  sympathy  and  synchro- 
nous action  of  the  Fallopian  tubes,  which  should  grasp  and. 
receive  the  ovum.  In  other  instances  the  ovum  has  been  re- 
ceived into  the  Fallopian  tubes,  but  either  from  a want  of  suffi- 
cient dilatation  and  action  in  them,  they  have  not  been  able  to 
propel  it  forward,  or  the  ovum  taking  upon  it  that  action  which 
is  destined  to  form  its  connections  with  the  uterus,  adheres,  and 
is  enlarged  in  the  tube,  so  that  it  cannot  be  conveyed  down  in- 
to the  womb. 

But  the  most  curious  instance  of  the  extra  uterine  conception 
is,  where  after  impregnation  the  ovum  has  dropt  from  the  ova- 
rium, and  lies  in  the  cavity  of  the  abdomen  amongst  the  visce- 
ra. Here  also  the  vessels  of  the  fleecy  chorion  spread,  and 
.attach  themselves  to  the  surface  of  the  viscera. 

These  instances  of  deviation  from  the  natural  action  of  the 
parts,  after  conception,  prove  to  us,  I think,  that  from  the  mo- 
ment of  impregnation  there  is  a principle  of  life  and  activity  in 
the  system  of  vessels  of  the  ovum,  and  that  at  a stated  period 
this  action  becomes  such,  that  the  efflorescent  vessels  of  the 
surface  of  the  ovum,  attach  themselves  to  whatever  vascular 
surface  they  are  in  contact  with.  Further,  it  seems  to  shew, 
that  in  the  womb,  and  in  the  deciduous  membrane  which  it 
prepares  for  the  reception  of  the  ovum,  there  is  nothing  very 
particularly  necessary,  and  that  any  vascular  surface  will  take 
upon  it  the  same  changes,  and  being  excited  probably  to  some 
peculiarity  of  action,  will  in  every  thing  essential  supply  the 
growth  and  nourishment  of  the  ovum  and  foetus. 

It  shows  us  how  far  the  action  previous  and  consequent  tG 
impregnation  is  a universal  and  sympathetic  excitement  of  the 
uterine  system  ; that  the  decidua  is  formed  in  the  cavity  of  the 


172 


OF  THE  WOMB. 


womb,  although  the  ovum  does  not  descend.  This  points  out 
to  us  how  careful  nature  is,  that  there  shall  be  a reciprocal  ac- 
tion in  the  ovum  and  womb,  so  as  to  ensure  the  adhesion  of  the 
ovum,  and  the  read)’  supply  of  a proper  nidus  for  it,  when  it 
shall  have  descended  into  the  cavity  of  the  womb.  It  informs 
us,  that  the  uterus  is  a spongy  and  vascular  bed,  having  pecu- 
liar sympathies  which  actuate  its  vessels,  and  a form  of  vessels 
adapted  to  quick  acceleration  of  action  so  as  to  grow,  enlarge, 
and  supply  the  secundines  with  nourishment. 

It  is  not,  however,  in  the  mere  adhesion  and  supply  afforded 
to  the  foetus,  that  the  peculiar  adaptation  of  the  womb  for  the 
reception  of  the  lostus  is  shown,  but  in  the  provision  for  the  de- 
livery of  the  child  at  a regular  and  stated  period.  For,  it  is  a 
curious  fact,  that  in  the  case  of  extra-uterine  foetus,  on  the  ex- 
piration of  the  nine  months,  the  uterus  takes  upon  it  that  ac- 
tion, and  that  excitement  of  its  muscularity  which  is  destined 
to  expel  the  foetus.  Accordingly  we  find,  that  at  the  usual 
time  of  utero-gestation,  there  are  pains  excited,  and  flooding, 
with  the  discharge  of  the  decidua  from  the  womb,  although  it 
contains  no  foetus. 

Nay,  further  it  would  appear  from  the  result  of  several  cases, 
that  at  the  expiration  of  the  natural  term  of  utero-gestation,  the 
foetus  indicates  that  it  is  governed  by  prescribed  laws,  which 
render  a change  necessary,  and  show  that  its  system  is  no  lon- 
ger fit  to  be  supplied  through  the  placentary  vessels,  and  as  in 
the  situation  of  extra-uterine  foetus  this  change  cannot  take 
place,  it  dies  and  becomes  with  its  secundines,  as  a load  of  fo- 
reign or  dead  matter  in  the  belly.  This  event  is  generally  fol- 
lowed by  the  death  of  the  mother,  though  sometimes  an  abscess 
has  opened  and  discharged  the  foetus,  or  after  much  suffering, 
the  bones  have  been  discharged  by  stool,  with  much  matter  and 
colliquative  diarrhoea. 

Of  the  womb  at  the  full  period  of  gestation  and 

OF  DELIVERY. 

To  complete  this  view  of  the  female  parts  of  generation,  it 
remains  only  to  speak  of  the  state  of  the  parts  at  the  full  term 
of  nine  months,  and  to  observe  the  process  of  a natural  deli- 
very. 

The  rapid  increase  of  size  of  the  pregnant  womb  in  the 
short  space  of  nine  months,  is  perhaps  the  most  surprising 
phenomenon  of  the  whole  animal  oeconomy,  it  shows  the  pow- 
er of  a peculiar  excitement,  in  calling  into  action  a partial  and 
local  system  of  vessels.  This  state  of  pregnancy  is  the  furthest 
from  a state  of  distention,,  in  so  much,  that  it  is  observed  the 


OF  THE  WOMB. 


173 


womb  feels  peculiarly  soft  on  impregnation,  and  as  if  but  im- 
perfectly filled  by  the  ovum.  This  soft  state  is  a sign  of  vas- 
cular action.  We  may  often  observe  in  the  discussion  of  a tu- 
mour, that  before  any  change  takes  place,  it  swells  and  becomes 
sofc,  and  this  even  where  the  tumour  is  about  to  be  absorbed. 

The  fundus  of  the  uterus  is  the  part  first  enlarged  ; and  af- 
terwards the  inferior  parts  ; at  length  the  cervix  is  obliterated, 
and  the  uterus,  which  was  originally  pyriform,  becomes  nearly 
oval,  and  the  distention,  as  we  have  remarked,  is  greatest  on  the 
back  part  of  the  womb.  In  the  first  months  the  uterus  sinks 
lower  in  the  pelvis,  they  say,  from  its  weight,  but  the  specific 
weight  of  the  uterus  is  not  increased,  and  on  that  account  it 
should  not  sink  deeper  ; it  is,  perhaps,  rather  from  its  enlarge- 
ment, and  the  difficultv  with  which  the  fundus  makes  its  way 
among  the  viscera  in  the  brim  of  the  pelvis.  Having  descend- 
ed considerably,  the  os  tincse  projects  further  into  the  vagina, 
but  the  fundus  continuing  to  enlarge,  at  last  emerges  from  the 
circle  of  the  bones,  and  then  from  the  conical  form  of  the  ute- 
rus, it  sometimes  rises  suddenly  out  of  the  pelvis  ; now  the  va- 
gina will  be  found  elongated,  and  the  os  tincse  removed  from 
the  point  of  the  finger. 

Now  the  ligaments  of  the  womb  direct  it  forward,  and  it 
rises  close  upon  the  abdominal  paries,  and  before  the  bowels  ; 
in  the  first  pregnancy  it  rises  almost  directly  up  ; in  subsequent 
pregnancies  from  the  greater  relaxation  of  the  integuments 
and  the  abdominal  muscles,  it  is  allowed  to  fall  more  forward  ; 
about  the  fourth  month  of  pregnancy,  the  womb  may  be  felt  in 
the  abdomen,  and  rising  out  of  the  pelvis  ; in  the  fifth  month 
the  fundus  is  about  half-way  betwixt  the  pubes  and  navel ; in 
the  seventh,  it  is  about  half-way  betwixt  the  navel  and  scrobi- 
culus  chordis  ; in  the  eighth,  it  is  at  its  highest,  and  towards 
the  end  of  the  ninth  month,  it  rather  subsides.  Finally,  im- 
mediately before  labour  it  descends  remarkably,  and  shifts  into 
the  middle  of  the  pelvis,  so  as  fairly  to  present  the  orifice  of 
the  womb. 

The  muscularity  of  the  uterus  is  increasing  from  the  first 
moment  of  pregnancy.  As  the  uterus  increases  in  thickness- 
and  is  distended,  the  muscular  fibres  become  more  distinct,  and 
their  power  of  contraction  greater  ; but  what  is  very  particular 
is  the  very  great  muscular  efforts  made  by  the  womb  during 
labour  by  these  fibres,  which  have  not  till  that  time  felt  the  sti- 
mulus to  action,  or  been  allowed  to  contract. 

When  the  period  for  the  approach  of  labour  is  arrived,  the 
nature  of  that  viscid  secretion  which  seals  up  the  orifice  of  the 
womb  is  altered,  it  loses  its  viscidity,  and  all  the  parts  are  re- 
laxed and  prepared  for  the  transmission  of  the  head  ; even 


174 


OF  THE  WOMB. 


those  rigidities,  strictures,  or  callosities  of  whatever  kind* 
which  would  seem  to  promise  an  absolute  obstruction  to  the 
passage  of  the  child,  yield  and  relax  previous  to  labour.  The 
action  of  the  womb  is  at  first  feeble,  as  might  be  expected,  and 
accoucheurs  have  marked  these  stages  of  a natural  labour. 

1st.  The  womb  has  suffered  no  diminution  of  its  size  ; the 
membranes  are  entire,  and,  of  course,  the  contractions  of  the 
womb  are  feeble,  because  before  it  is  allowed  to  make  some 
contraction  its  efforts  are  not  strong.  This  is  a provision  lor 
the  first  stage  of  labour  being  slow  ; by  and  by  the  orifice  di- 
lating, the  membranes  with  the  waters  are  felt  protruding. 
The  membranes  and  water  is  as  a soft  conical  cushion,  gently 
dilating  the  passage  ; and  in  this  stage  there  should  be  no 
officious  interference.  While  the  membranes  are  entire,  both 
the  mother  and  child  are  in  perfect  safety. 

2d.  The  orifice  continuing  to  dilate,  and  the  efforts  of  the 
womb  increasing,  the  membranes  burst,  and  the  head  of  the 
child  presses  on  the  orifice  ; then  the  womb  is  allowed  to  con- 
tract : this  contraction  is  a stimulus  to  greater  efforts,  and,  in  a 
few  pains,  the  head  descends  into  the  cavity  of  the  pelvis.  The 
orifice  is  completely  retracted,  and  there  is  no  longer  a mark  of 
division  betwixt  the  womb  and  the  vagina  ; they  are  as  one 
canal.  If,  however,  the  membranes  are  burst  too  early,  the 
labour  is  not  accelerated,  but  retarded.  The  orifice  is  notf 
dilated  by  the  soft  and  elastic  membranes  ; the  head  of  the 
child  presses  broad  on  the  orifice,  which  becomes  rigid,  and 
perhaps  inflamed,  its  dilatation  is  slow,  and  the  labour  tedious. 
Though  from  the  form  of  the  bones,  and  particularly  by  the 
retiring  of  the  sacrum,  there  is  a provision  and  guard  for  the 
soft  parts  of  the  mother  against  compression  by  the  head  ; yet 
nature  intends  this  stage  to  be  short,  for  it  is  the  period  of 
danger.  There  is  now  obstruction  of  urine  and  faeces,  and  the 
vessels  of  the  parts  suffer  compression. 

3d.  Now  the  head  of  the  child  presenting  at  the  orifice  of 
the  vagina,  forms  a third  stage  ; it  is  the  stage  of  most  exquisite 
suffering  : the  head  is  pushed  forward  during  every  pain,  and 
recedes  again  in  the  absence  of  pain.  An  interval  of  rest  pre- 
cedes this  stage,  at  last  the  pains  return,  and  the  hard  head  of 
the  child  coming  to  press  on  the  orifice,  and  the  womb  coming- 
in  close  contact  with  the  body  of  the  child,  the  pains  are  redou- 
bled in  strength.  The  face  of  the  woman,  perhaps,  before  pale 
and  flat,  becomes  red  and  turgid,  the  eyes  gleam,  and  are  in- 
flamed ; the  pulse  becomes  quick  and  hard  ; and  from  the  ex- 
quisite expectation  of  relief,  she  looks  wildly  round  on  her  at- 
tendants, losing  all  reason  and  recollection  ; she  is  frantic,  with 
the  most  agonizing  pain  to  which  the  human  frame  is  subject. 


OF  THE  WOMB. 


175 


Now  the  occiput  of  the  child  begins  to  project  with  its  wrinkled 
scalp  through  the  external  parts,  but  nature  intends  that  this 
also  should  dilate  slowly  ; the  ligaments  and  os  coccygis  resist 
several  throes,  and  direct  the  head  forward  under  the  pubes  ; 
at  last,  after  several  pains,  it  rises  with  a half  turn,  and  is  de- 
livered. 

4th.  The  fourth  stage,  is  the  delivery  of  the  body  and  shoul- 
ders ; and, 

5th.  The  fifth  stage,  is  the  delivery  of  the  placenta.  The 
placenta  is  expelled  by  a continuation  of  the  same  action  of  the 
womb,  and  is  part  of  the  natural  process.  First  a flow  of  the 
liquor  amnii  and  blood  follows  the  child,  and  the  woman  lies  for 
a time  exhausted  ; the  extreme  pain  and  excitement  having 
ceased.  The  womb  generally  recovers  its  powers  in  about 
twenty  minutes,  and  then  there  is  grinding  pain  in  the  belly, 
and  the  placenta  is  detached  and  expelled,  or  is  pushed  down 
into  the  vagina. 

Thus  we  have  sketched,  in  the  most  superficial  manner,  the 
progress  of  a natural  labour,  with  a view  merely  to  explain  the 
general  notion  of  the  entire  function  of  the  womb,  not  with  that 
minuteness  which  the  accoucheur  would  look  for  in  treating 
the  subject.  Let  us,  for  an  instant,  attend  to  the  state  of  the 
umbilical  chord,  and  the  final  contraction  of  the  womb. 

I have  already  observed,  that  while  the  membranes  are  un- 
broken, the  child  is  safe,  that  is  to  say,  there  is  no  danger  of  the 
compression  of  the  umbilical  chord  ; but  when  the  membranes 
have  burst,  and  the  waters  are  evacuated,  the  chord  must  suf- 
fer a degree  of  compression  betwixt  the  uterus  and  the  child, 
and  there  is  danger  that  the  chord  may  fall  down  before  the 
head,  until  the  head  has  descended  into  the  brim  ; as  the  uterus 
contracts,  and  as  it  were  follows  the  child,  the  circulation 
through  the  placenta  must  become  somewhat  difficult,  and  the 
usual  function  corresponding  with  that  of  the  adult  lungs  im- 
paired. This  must  be  much  more  the  case  when  the  child  is 
delivered,  and  the  placenta  remains  in  the  contracted  womb. 
No  doubt  nature  intends  by  this,  that  the  function  of  the  pla- 
centa shall  be  gradually  diminished,  and  not  suddenly  cut  off, 
that  the  child  may  feel  occasion  for  the  play  of  the  muscles  of 
respiration,  and  that  the  function  of  the  lungs  may.  by  degrees, 
take  place  of  the  function  of  the  placenta.  When  the  child  is 
first  delivered,  the  chord  pulsates  stronglv  ; when  the  child 
cries,  it  becomes  feeble  ; at  first,  the  child  has  strong  and 
irregular  catches  of  the  respiratory  muscles,  but  by  and  by  it 
breathes  more  regularlv,  and  cries  lustily.  At  first  the  breath- 
ing only  renders  the  pulsation  of  the  chord  feeble,  but  presently 
the  pulsation  becomes  so  weak,  that  it  is  felt  only  near  the 


176 


OF  THE  WOMB. 


umbilicus,  and  it  ceases  when  the  regular  and  interrupted 
breathing  is  established,  and  the  crying  ceases. 

The  delivery  of  the  child  and  placenta  is  followed  by  a'con- 
siderable  efflux  of  blood.  But  after  this  there  continues  a dis- 
charge from  the  uterus,  which  is  called  the  lochia.  It  is  like 
the  exudation  of  blood  from  an  extensive  wound,  in  as  much 
as  by  the  contraction  of  the  vessels  from  which  it  flows,  it  be- 
comes serous  in  a few  days,  and  ceases  gradually  like  a hse- 
morrhagy. 

This  open  discharge  from  the  womb  after  delivery,  is  no 
doubt  a provision  against  the  consequence  which  would  natu- 
rally result  from  the  sudden  and  perfect  obstruction,  and  the 
activity  of  the  uterine  vessels  consequent  on  delivery.  By  this 
discharge  the  activity  of  the  vessels  is  gradually  relieved,  and 
as  it  is  a discharge  taking  place  of  the  active  state  of  the  womb, 
so  the  secretion  of  the  milk  in  the  breasts,  and  the  giving  of 
suck,  causes  the  discharge  to  cease  much  sooner  than  it  would 
do  if  the  mother  were  not  the  nurse. 


OF  THE  M A MM/E. 

In  man  and  in  children  of  both  sexes,  there  is  no  mark  of 
the  breast,  but  the  little  cutaneous  papilla,  or  nipple.  These 
tubercles  are,  however,  surrounded  by  a zone  or  disk,  of  a 
brownish  red  colour,  the  areola. 

At  puberty,  as  we  have  said,  the  breast  of  the  female  becomes 
protuberant,  and  those  parts  which  were  in  miniature,  and 
without  action,  quickly  grow  into  a firm  glandular  mass  (speak- 
ing anatomically.)  The  shape,  rotundity  and  firmness  of  the 
gland  depends  much  upon  the  adipose  membrane  surrounding 
and  intersecting  the  glandular  body. 

The  glandular  part  itself  is  divided  into  little  masses,  which 
again  consist  of  small  granules.  These  several  subdivisions  of 
the  glands  are  closely  surrounded  by  membranes. 

The  lactiferous  ducts  are  gathered  together  from  these  les- 
ser granules,  and  unite  into  twelve  or  fifteen  in  number  of  a 
very  considerable  size,  as  they  converge  towards  the  root  of  the 
nipple.  When  milk  is  secreted,  the  glands  are  large,  a re- 
markable distention  of  the  ducts  also  takes  place,  for  they  are 
then  become  tortuous  and  varicose,  and  serve  as  reservoirs  of 
the  milk.  Where  they  pass  through  the  nipple,  however,  they 
are  again  contracted,  and  open  by  small  pores  upon  its  surface. 
The  nipple  is  of  a spongy  and  elastic  nature,  and  suffers  a dis- 
tention or  erection.  When  the  nipple  is  contracted,  the  lactife- 
rous ducts  must  be  compressed,  and  perhaps  coiled  together,  so 


OF  THE  WOMB. 


17? 


that  the  milk  cannot  flow,  or  flows  with  difficulty  : but  by  the 
sucking  of  the  child,  the  nipple  is  distended,  and  the  ducts 
elongated,  so  that  the  milk  flows.  There  open  upon  the  areola 
several  superficial  or  cutaneous  glands,  which  pour  out  a dis- 
charge to  defend  it  and  the  nipple  from  excoriation. 

Of  the  arteries,  veins,  or  lymphatics  of  the  mammae,  we 
need  not  treat  here. 

We  have  many  occasions  to  observe  the  consent  and  sympa- 
thy which  exist  betwixt  the  womb  and  the  breasts.  On  the 
first  period  of  the  menses,  the  breasts  are  much  distended.  In 
many  women  at  each  return  of  the  discharge,  a degree  of 
swelling  and  shooting  pain  is  felt  in  them,  and  the  enlargement 
and  shooting  pain  in  the  breast,  with  the  darker  colour  of  the 
areola,  is  marked  as  the  most  prominent  sign  of  pregnancy : 
with  the  ceasing  of  menstruation,  which  is  the  cessation  of  the 
usual  excitement  and  action  of  the  womb,  the  breasts  contract 
and  are  absorbed.  Any  unusual  stimulus  or  irritation  in  the 
womb,  as  polypus,  or  cancers,  or  even  prolapsus  and  excoria- 
tion, will  affect  the  breasts,  causing  them  to  enlarge  and  be- 
come painful. 

When  the  function  of  the  parts  cease,  they  seem  to  feel  the 
want  of  the  usual  excitement  to  correct  action,  and  are  apt  to 
fall  into  disease  ; so  it  is  at  least  with  the  womb  and  mammae, 
for  at  that  period  of  life,  when  the  system  is  no  longer  able  to 
support  and  give  nourishment  to  a child,  and  these  parts  sub- 
side from  their  usual  action,  they  often  become  schirrous  or 
cancerous,  and  terminate  existence  by  a tedious,  painful,  and 
loathsome  disease. 


Vol.  IV. 


PART  THE  FOURTH. 


OF  THE  LYMPHATIC  AND  LACTEAL 
SYSTEMS  OF  VESSELS . 


CHAP.  I. 


OF  THE  LYMPHATIC  AND  LACTEAL  SYSTEMS 
OF  VESSELS. 


INTRODUCTORY  VIEWS. 

E have  understood  that  the  red  blood  circulates  in  the 
body,  through  vessels  (the  arteries  and  veins)  which  have  a 
direct  communication  at  their  extremities  by  inosculation  ; that 
although  these  vessels  lie  parallel  to  each  other,  and  extend 
from  the  heart  to  the  remotest  part  of  the  body,  yet  the  blood 
is  said  to  pass  through  the  circulation,  because  it  is  transmitted 
from  the  veins  into  the  arteries  through  the  medium  of  the 
heart ; and  from  the  extremities  of  the  arteries  directly  into 
the  veins,  returning  again  to  the  centre.  In  this  transmission 
of  the  blood  through  continuous  tubes,  there  is  in  the  coats  of 
the  vessels  an  alternation  of  contraction  and  relaxation  which 
impels  it  forward.  But  besides  these  arteries  and  veins  carry- 
ing the  red  blood  through  the  body,  there  are  other  vessels 
more  remote  in  their  connection  with  what  is  generally  called 
the  circulating  system  of  vessels. 


180 


OF  THE  CAPILLARY  VESSELS*. 


SECTION  I. 

or  THE  CAPILLARY  VESSELS. 

The  capillary  vessels  ate  those  extreme  branches  which  are 
as  minute  as  hairs  ; but  this,  though  the  literal,  is  not  the  ge- 
neral meaning  of  the  term.  By  capillary  vessels  is  rather  un- 
derstood those  branches  in  which  the  changes  are  wrought 
from  the  blood,  and  which  are  either  so  minute  as  not  to  allow 
the  promiscuous  flow  of  the  blood,  or  possessed  of  such  a ' 
degree  of  irritability  and  appetency,  as  only  to  allow  certain 
parts  of  that  fluid  to  be  transmitted. 

It  is  proved  that  in  the  living  body  there  is  no  exudation  ; 
but  no  sooner  is  the  animal  dead,  than  the  fluids  exude  from 
the  vessels,  the  secretions  pass  through  the  coats  of  those 
receptacles  which  formerly  contained  them,  and  the  whole 
parts  partake  of  an  universal  colour.  From  this  simple  fact, 
we  are  led  to  think  that  a property  exists  in  the  living  fibre, 
which  by  contraction  or  some  other  property  repels  the  fluids. 
Admitting  this,  it  is  very  natural  to  suppose  that  the  fibres, 
and  more  particularly  the  vessels,  have  a discriminating  pro- 
perty ; so  that  the  capillary  texture  of  each  organ  possesses 
sensibility,  which  has  its  relations  to  the  fluids  passing  through 
them,  or  to  be  secreted  from  them. 

If  we  admit  this,  we  may  also  foresee  the  explanation  of  the 
most  puzzling  phenomenon  of  inflammation.  Inflammation 
is  the  effect  of  excitement : there  is  increased  action  of  the 
arteries  ; and  by  the  operation  of  the  same  cause,  there  is  a 
destruction  of  the  natural  sensibilities  of  the  capillary  vessels, 
so  that  they  no  longer  are  possessed  of  their  distinguishing 
sensibility,  and  they  admit  the  promiscuous  passage  of  the  red 
blood  : they  become  dilated  by  the  action  of  the  arteries,  and 
visibly  distended  with  red  blood.  The  effect  is  not  merely  the 
mechanical  derangement  of  the  particles  of  the  blood.  The 
chemical  changes  which  take  place  in  the  extreme  vessels  are 
disordered,  and  the  blood  deposits  upon  the  extreme  branches 
of  the  nervous  system  an  unusual  proportion  of  irritability  ; so 
that  with  the  redness  arising  from  the  circulation  of  red  blood 
through  the  hitherto  pellucid  vessels,  in  parts  not  endowed 
with  sensibility,  there  is  acquired  an  unusual  sensibility,  and 
the  power  of  transmitting  the  sensation  to  the  sensorium. 
Since  we  see  that  in  an  inflammatory  state  the  pellucid  veins 
transmit  red  blood,  and  that  this  red  blood  must  be  supplied  by 
the  serous  arteries ; then  it  is  proved  that  answering  to  the 
pellucid  arteries  (in  their  natural  state)  there  are  pellucid  veins. 


OF  THE  CAPILLARY  VESSELS. 


181 


We  should  acquiesce  therefore  in  the  opinion  that  supposes 
both  the  arteries  and  veins  to  have  pellucid  capillary  branches 
answering  to  each  other,  collateral  to  the  larger  and  more  pal- 
pable anastomosis  of  their  red  extremities.  These  anastomo- 
sing branches  of  the  arteries  and  veins  in  which  the  red  blood 
is  seen  to  circulate,  perpetuate  the  flow  of  the  greater  part  of 
the  blood  back  to  the  heart,  while  the  several  secretions  are 
performed  in  the  capillary  vessels  ; but  there  is  no  reason  to 
suppose  that  the  fluids  sent  from  the  arteries  into  these  pellucid 
capillary  vessels  are  all  poured  out  in  form  of  secretions  ; part 
returns  into  the  extremities  of  the  circulating  veins.  The 
secreted  fluids  and  solids  are  either  carried  away  by  ducts  into 
their  receptacles,  or  thrown  out  from  the  body  : while  those 
fluids  which  are  exuded  on  the  cellular  membrane  and  cavities 
are  re-absorbed  by  the  system  of  absorbent  lymphatics. 

We  say  then  that  arteries  terminate,  first,  in  red  veins  ; 
which  is  proved  by  the  microscope,  and  by  mercurial  and 
other  injections  : secondly,  in  glands  ; thirdly,  in  cells  receiv- 
ing red  blood  ; fourthly,  in  lymphatic  veins  ; fifthly,  in  ex- 
halents,  which  pour  their  fluids  into  the  cellular  membrane, 
cavities,  joints,  &c.  and  which  fluid  is  taken  up  by  the  valvular 
lymphatic  absorbents. 

But  these  absorbent  vessels,  of  which  we  are  now  to  treat 
under  the  division  of  lymphatics,  do  also  perform  a circula- 
tion, in  as  much  as  they  convey  back  to  the  centre  of  the  sys- 
tem the  fluids  which  have  been  thrown  out  from  the  extremi- 
ties of  the  arteries.  But  as  these  lymphatic  vessels  are  not 
continued  from  the  extremities  of  the  arteries  as  the  red  veins 
are,  as  they  imbibe  the  fluids,  which  have  been  thrown  out  of 
the  other  system ; their  fluid  contents  cannot  be  conveyed 
through  them  by  the  force  of  the  heart  and  arteries,  they  must 
be  peculiar  in  having  powers  within  themselves,  first  of  ab- 
sorbing, and  then  of  propelling  their  fluid  onward  to  the  heart. 

This  common  property  of  absorption  in  the  lymphatics,  ab- 
sorbents, and  lacteals,  and  their  being  connected  with  the 
same  trunk,  occasions  their  being  considered  as  one  system  of 
vessels  ; when,  in  fact,  looking  upon  the  general  ceconomy  of 
the  living  body,  we  find  them  ministering  to  very  different 
purposes.  The  one  branch  of  the  system,  the  lymphatics  (as 
we  have  seen  in  the  introduction  to  this  volume,)  takes  up  the 
matter  which  has  been  secreted,  and  poured  out  from  the 
arteries,  (viz.  all  the  solids  and  fluids  of  the  body,)  and  con- 
veys it  again  into  the  circulating  system.  The  lacteal  vessels, 
on  the  contrary,  are  those  vessels  which  opening  upon  the  inner 
surface  of  the  intestines  receive  into  them  the  nutritious  fluids, 
prepared  by  the  organs  of  digestion,  and  suited  to  supply  the 


182 


OF  THE  LYMPHATIC  SYSTEM. 


incessant  waste  and  destruction  of  the  solid  and  fluid  parts  of 
our  frame,  and  which  have  been  absorbed  and  carried  away  by 
the  lymphatics.  Following  this  simple  view,  although  the 
absorbent  system  be  commonly  divided  into  the  thoracic  duct, 
lymphatics,  lacteals,  and  glandular  apparatus  attached  to  them, 
I shall  throw  the  present  section  into  the  divisions  of  the 
lymphatics  and  of  the  lacteals. 

SECTION  II. 

OF  THE  LYMPHATIC  SYSTEM  IN  PARTICULAR. 

The  lymphatic  vessels  are  tubes  whose  coats  are  perfectly 
pellucid,  having  a remarkable  power  of  contraction,  which 
causes  them  to  shrink,  and  disappear,  so  as  to  render  it  difficult 
to  demonstrate  them.  Indeed  they  are  only  to  be  observed  by 
an  eye  accustomed  to  the  making  of  lymphatic  injections. 
They  are  called  lymphatics,  or  ductus  aqjjosi,  from  their 
transmitting  a fluid  colourless  as  water.  When  they  are 
distended  with  their  fluids,  they  show  that  they  possess  a very 
distinct  character  from  the  other  circulating  tubes.  They  are 
irregularly  distended,  knotty,  and  sometimes  like  a chain  of 
beads,  or  little  irregular  vesicles  connected  together.  This 
irregularity  is  owing  to  their  numerous  valves,  which  are 
semilunar  membranes,  like  those  of  the  veins,  and  hung  across 
their  cavities,  so  as  to  catch  and  interrupt  the  refluent  lymph. 
They  say,  in  general,  that  in  the  space  of  an  inch  the  lympha- 
tic vessel  has  three  or  four  pairs  of  valves.  But  this  bears  no 
certain  proportion  ; for  as  these  vessels  run  where  they  are  ex- 
posed to  occasional  compression  from  the  suri'ounding  parts, 
or  bear  the  weight  of  a high  column  of  fluid,  their  valves  are 
more  frequent.  The  lymphatics  are  improperly  called  cylin- 
drical tubes,  since  they  are  irregular  from  their  valves  branch- 
ing and  frequent  communications.  The  coats  of  the  lymphatic 
vessels  are  the  strongest  of  any  in  the  body  ; for  although  ex- 
tremely thin  and  pellucid,  they  give  resistance  to  distention 
beyond  a certain  point,  and  bear  a column  of  mercury  which 
would  burst  through  the  valves  of  veins,  and  tear  the  coats  of 
arteries.  If  there  be  a muscular  coat,  and  no  one  ever  denied 
the  muscularity  of  the  lymphatics,  then  we  may  reckon  three 
coats  : First,  The  inner  coat,  which  is  the  continuation  of  the 
inner  tunic  of  the  veins,  as  may  be  observed  in  the  opening  of 
the  thoracic  duct  into  the  left  subclavian  and  left  jugular  veins. 
It  is  smooth  and  polished,  forms  duplicatures  or  valves,  and 


OF  THE  GLANDS  OF  THE  ABSORBENT  SYSTEM.  188 

prevents  the  transudation  of  their  fluids  : it  is  connected  by 
cellular  membrane  to  the  middle  coat.  Secondly,  The  mus- 
cular or  middle  coat,  which  consists  chiefly  of  muscular  fibres, 
which,  according  to  Sheldon,  run  in  every  possible  direction, 
though  the  greater  number  take  the  circular  direction.  And, 
lastly,  the  outer  coat,  which  is  connected  with  the  general  in- 
vesting cellular  membrane.  As  the  inner  coat  must  chiefly 
form  the  valves,  and  as  valves  possess  so  wonderful  a power  of 
resisting  the  column  of  mercury,  I should  hold  that  the  inner 
■coat  is  that  on  which  the  strength  and  resistance  to  distention 
of  the  lymphatics  depends,  though  it  has  been  said  that  it  is  to 
the  outer  coat  that  they  owe  this  property.  The  muscularity 
of  these  vessels  is  rather  inferred  than  proved  : it  is  inferred 
from  the  unassisted  action  which  they  have  to  perform  in 
pressing  the  absorbed  fluids  onward  to  the  heart.  Neverthe- 
less we  sometimes  see  the  ly  mphatics  of  the  lower  extremities 
of  a colour  so  red  and  fleshy,  that  we  may  say  their  muscu- 
larity is  demonstrable. 

The  lymphatics  seem  to  possess  little  elasticity  ; when  they 
are  blown  into,  they  rise  with  the  slightest  force,  and  remain 
distended,  although  the  passage  of  the  air  forward  be  uninter- 
rupted : whereas,  had  they  considerable  elasticity',  they  would 
contract  and  disappear.  Indeed,  when  empty",  in  the  dead 
body  they  may  be  rather  said  to  be  collapsed  than  contracted. 
Although  the  lymphatics  can  be  distended  with  the  slightest 
inflations,  yet  when  distended,  as  we  have  already  observed, 
they  firmly  resist  further  dilatation.  This  is  a quality  neces- 
sary to  their  valvular  structure,  lor  if  thev  were  elastic  beyond 
this  degree  of  dilatation,  the  caliber  of  the  vessel  would  be  oc- 
casionally so  enlarged  as  to  render  the  valves  incapable  of 
meeting,  and  of  preventing  the  retrograde  movement  of  the 
fluids. 


SECTION  III. 

OF  THE  GLANDS  OF  THE  ABSORBENT  SYSTEM. 

Every  where  throughout  the  body  and  viscera  betwixt  the 
extreme  branches  of  the  absorbent  system  and  the  trunk,  glan- 
dular bodies  are  interposed.  Though  of  various  forms  they 
are  generally  of  an  oval  shape,  and  they  vary  in  size  from 
the  twentieth  part  of  an  inch  to  a full  inch  in  diameter. 
Sometimes  they  are  segregated,' — sometimes  accumulated  and 


184  OF  THE  GLANDS  OF  THE  ABSORBENT  SYSTEM. 

clustered  together.  The  colour  of  those  bodies  is  various  in 
the  several  parts  of  the  body  : in  young  animals  they  are  red- 
der, and  become  pale  only  with  age.  They  are  redder  and 
stronger  in  the  outer  parts  of  the  body,  as  in  the  thigh,  axilla, 
&c.  less  so  within  the  abdomen  and  thorax.  2.  The  latter 
will  not  bear  so  high  a column  of  mercury  as  the  former.  The 
mesenteric  glands  are  said  totally  to  disappear  in  old  age.* 

It  would  appear  that  the  glands  of  this  system  are  of  more 
importance  to  young  animals  than  to  adults.  In  the  icetus 
and  in  children  the  lacteal  and  lymphatic  glands  are  exceeding- 
ly numerous  ; but  they  shrink  or  disappear  with  old  age.  In 
the  foetus,  indeed,  they  can  be  of  no  very  essential  use  ; they 
are  then  rather  in  a state  of  preparation  for  the  actions  neces- 
sary in  infancy  and  youth.  It  is  then  also  that  they  are  most 
liable  to  disease,  and  seem  more  irritable  and  ready  to  inflame, 
especially  in  superficial  situations.  About  the  age  of  fourteen 
or  fifteen  this  disposition  is  changed,  which  is  commonly  said 
to  proceed  from  the  increased  vigour  of  the  constitution,  and 
the  change  which  then  takes  place  on  the  organs  of  generation. 
It  is  rather  to  be  attributed,  however,  to  the  diminution  of 
irritability  and  activity  of  their  vessels  in  verging  to  the  adult 
state,  which  is  marked  by  their  comparatively  less  size,  and 
smaller  degree  of  vascularity.  We  may  further  observe  that 
the  lymphatic  glands,  even  in  the  scrophulous  diseases,  are 
seldom  primarily  affected  : that  they  partake  of  diseased  ac- 
tion from  the  surface,  or  from  an  affection  of  the  intestines, 
or  from  the  absorption  of  matter.  The  structure  of  these 
glands  has  not  been  satisfactorily  investigated  ; or  the  inqui- 
ry is  attended  with  insurmountable  difficulties.  Some  anato- 
mists have  said,  that  they  consisted  of  the  convoluted  absor- 
bent vessels  ; others  that  they  are  of  a cellular  structure. 
When  they  affirm  that  these  cells  are  totally  distinct  from  the 
lymphatic  vessels,  it  is  not  so  easy  to  understand  them  : for 
cells  communicating  with  each  other,  and  into  which  the  lym- 
phatic vessels  enter,  are  very  much  the  same  with  a series  of 
convoluted,  varicose,  and  irregularly  dilated  vessels.  If  we 
could  dissect  this  series  of  cells,  as  Haller  did  the  vesicuke 
seminales,  we  should  have  represented  to  us  the  appearance  of 
a convoluted  varicose  vessel. 

There  is  a coat  of  cellular  membrane  which  surrounds  the 
glands.  This  coat  is  pervaded  by  a peculiar  fluid  which  has 
given  rise  to  some  speculation.  It  is  observed  chiefly  in 
young  animals,  and  is  for  the  most  part,  though  not  always, 
white  and  milky,  and  in  the  glands  of  the  lungs  it  is  of  a black- 


By  Ruyfch,  Morgagni,  Haller;  Sheldfln- 


ORIGIN  OF  THE  LYMPHATICS,  &C. 


185 


ish  colour.  This  is  the  fluid  which  having  globules  in  it,  was 
supposed  by  Mr.  Hewson  to  be  the  first  stage  of  the  formation 
of  the  red  globules  of  the  blood.  It  is  distinct  from  the  ab- 
sorbed fluids,  and  is  a secretion  from  the  arteries.  Physiolo- 
gists have  not  determined  the  nature  or  use  of  this  fluid. 

At  present  there  seems  no  better  hypothesis  to  be  offered 
regarding  the  use  of  the  lymphatic  and  lacteal  glands,  than  that 
they  serve  to  check,  controul,  and  measure  the  flow  of  the  ab- 
sorbed fluids  into  the  mass  of  the  blood : without  them  it  ap- 
pears to  me  probable  that  at  one  time  the  lymph  returning  from 
the  body,  or  at  another  time  the  chyle,  might  flow  too  rapidly, 
and  in  a disproportioned  quantity  into  the  veins  and  heart. 
But  by  the  check  which  the  glands  impose  upon  this  flow, 
giving  a remora  and  serving  as  receptacles  of  the  absorbed 
fluids,  those  fluids  are  poured  with  a more  uniform  and  con- 
stant flow  upon  the  heart. 


SECTION  IV. 

©RIGIN  OF  THE  LYMPHATICS,  AND  OF  THE  DOCTRINES  OF 
ABSORPTION. 

The  lymphatics,  forming  a system  of  absorbents,  %ve  might 
say,  in  general,  that  they  take  up  all  the  fluids  which  have  been 
thrown  out  upon  the  surfaces  of  the  body.  Thus  they  arise 
from  the  surface  of  the  skin  ; from  the  surface  of  the  cavities 
and  viscera  covered  by  the  pleura  and  peritoneum  ; from  the 
cells  of  the  interstitial  and  adipose  membrane,  &c.  This  is 
the  simple  use  assigned  to  this  system  of  vessels  : but  whe- 
ther they  are  the  only  system  of  absorbents  ; whether  they  car- 
ry away  all  the  parts  of  the  system,  fluids  and  solids  ; whe- 
ther they  absorb  the  muscles,  membranes,  bones,  tendons, 
See.  of  which  the  solid  body  consists,  is  a question  requiring 
severe  examination.  It  cannot  be  denied  that  although  the 
system  and  doctrines  of  absorption  be  the  most  beautiful  and 
interesting,  and  apparently  the  simplest  in  the  whole  (econo- 
my, yet  it  is  founded  on  very  few  facts,  while  there  is  much 
doctrine  tacitly  acknowledged,  which  seems  in  symmetry 
with  the  facts  and  the  laws  of  the  (economy,  but  which  is  not 
founded  in  absolute  proof.  We  shall  first  examine  the  proofs 
of  the  lymphatics  being  the  vessels  which  absorb  the  fluids  of 
the  cavities  and  surfaces  of  the  bodv.  The  animal  machine 
Vol.  IV.  2 A 


186 


ORIGIN  OF  THE  LYMPHATICS, 


universally  partakes  of  motion.  A principal  provision  for 
this  mobility  of  parts,  is  the  looseness  of  the  cellular  mem- 
brane which  every  where  pervades  the  body,  and  supports 
the  vessels  and  connects  the  several  parts.  This  interstitial 
membrane  is  elastic,  and  being  cellular,  to  allow  of  motion,  its 
surface  is  bedewed  with  serous  exudation.  This  fluid  is  per- 
petually passing  from  the  extremities  or  sides  of  the  lymphatic 
arteries  or  capillaries,  into  the  cellular  membrane,  and  upon 
all  the  cavities  of  the  body.  The  fluid  extravasated  is  called 
lymph,  and  some  have  supposed  that  it  passes  through  in- 
organized  pores,  an  expression  that  is  not  very  intelligible  ; 
but  if  by  this  is  meant  (as  has  sometimes  been  explained) 
“ accidental  pores”  in  the  sides  of  the  vessels,  it  is  a suppo- 
sition quite  improbable  and  unlikely.*  The  pores  or  ves- 
sels from  which  this  fluid  exudes  are  called  exhalent ; and 
their  action  is  no  doubt  as  completely  secretion  as  that  which 
produces  the  fluids,  which  in  our  wisdom  we  call  more  per- 
fect secretions. 

That  the  lymphatics  take  up  the  fluids  thrown  out  in  the 
cavities  of  the  body,  as  the  abdomen,  thorax,  pericardium, 
&c.  there  is  what  nearly  amounts  to  an  absolute  proof,  in  com- 
paring the  fluids  of  those  cavities  with  that  contained  in  the 
vessels,  for  by  the  experiments  of  Hewson  it  is  found  that  if 
the  fluid  moistening  the  cavities  be  collected,  it  will  form  a 
jelly  when  exposed  to  the  air,  as  the  coagulable  lymphatic 
does.  Again,  if  a lymphatic  vessel  be  tied  up  in  a living  ani- 
mal, and  then  opened  so  as  to  allow  the  fluid  to  flow  into  a cup, 
it  will  also  form  a jelly  like  the  coagulable  lymph. f The 
fluid  of  cavities  alters  in  animals  diseased  ; sometimes  retain- 
ing its  coagulability,  and  even  acquiring  stronger  powers  ; 
sometimes  losing  it  altogether.  But  what  is  most  essential  to 

* Dr  Hunter  fupportcd  this  opinion  (Commentaries  p.  40.)  viz.  “ that  the 
fluids  of  cavities  were  collected  by  tranfudation,  and  rot  thrown  out  by  exha- 
lents an  opinion  which  could  only  have  arifen  from  not  correcting  the  ideas 
received  in  making  injections  in  the  dead  body  by  the  phenomena  of  the  living 
fyftem.  See  Heufon  on  the  Lymphatic  fyjiem,  chap.  viii.  where  the  opinion  of  in- 
orgsnical  filtering  is  fuccefsfully  combated. — See  alfo  Cruickfhanks. 

f But,  by  difeafe,  the  fluid  in  the  cavities  and  cellular  membrane  is  altered. 
In  dropfv,  for  example,  the  fluid  of  the  abdomen  lofes  the  property  of  coagulating 
on  mere  txpofure  ; it  comes  to  refemble  more  the  ferum  of  the  blood  : this  were 
fufficient  proof  that  the  collection  is  not  owing  merely  to  the  diminifhtu  abforp- 
tion,  but  that  there  is  a change  of  action  in  the  veflels  of  the  peritoneum,  pleura, 
pericardium,  &c.  An  inflammatory  action  of  the  veflels  will  throw  out  a fluid 
more  coagulable,  and  which,  in  a high  degree  of  action,  will  form  a film  of 
coagulable  lymph  or  even  pus  on  the  furface.  But  in  a flate  the  reverfe  of  inflam- 
mation, iuch  lor  example  as  the  debility  following  inflammation,  a ferous  effufion 
will  be  poured  out,  having  little  tendency  to  coagulate. 


AND  OF  THE  DOCTRINE  OF  ABSORPTION. 


187 


our  present  purpose,  it  has  been  observed,  that  whatever  change 
takes  place  in  the  fluids  of  the  cavities,  the  same  is  found  to 
have  taken  place  in  the  lymphatics. 

But  the  student  naturally  asks,  how  is  the  lymph  taken  into 
the  lymphatic  vessels  ; and  here  it  must  be  confessed,  there  is 
too  much  field  for  conjecture. 

It  was  thought  formerly  that  the  lymphatic  arteries  termi- 
nated in  small  pellucid  veins  : these  veins  carrying  only  the 
thinner,  and  refusing  the  red  part  of  the  blood,  were  called  lym- 
phatics. When  the  anatomist  threw  in  his  minute  injection, 
and  saw  the  coloured  fluid  return  bv  the  red  veins,  and  the  co- 
lourless fluid  return  by  the  lymphatics,*  it  was  held  as  a suffi- 
cient proof  of  the  accuracy  of  the  pre-conceived  notion,  and 
tallied  with  observations  of  Leewenhoeck,  and  the  theory  of 
Boerhaave.  See  Introduction  to  Vol.  III.  When,  however, 
anatomists  more  carefully  examined  the  state  of  parts,  they 
found  that  the  lymphatics  were  not  filled,  unless  the  cellular 
membrane  was  previously  injected  by  the  extravasation  of  the 
fluid  from  the  blood  vessels.  Finding  that  this  alleged  experi- 
ment was  really  no  proof  of  the  anastomosis,  and  direct  com- 
munication betwixt  the  extrenfe  arteries  and  lymphatics,  they 
conceived  that  it  was  a proof  that  these  lymphatics  took  their 
rise  from  the  cellular  interstitial  texture.  Then  injecting  with 
mercury,  they  found  that  when  the  vessels  burst,  and  the  co- 
lumn suddenly  descended,  and  the  cellular  membrane  was  fill- 
ed, the  mercury  was  seen  to  rise  in  the  lymphatics.  Following- 
up  this,  they  blew  air,  of  injected  various  fluids  directly  into 
the  cellular  membrane,  and  injected  the  lymphatics.  Thus  by 
an  error,  by  an  accidental  effect  of  their  injection,  the  minds  of 
Dr.  Hunter  and  Monro  were  opened  to  a freer  discussion  of 
the  received  opinions  and  approved  authorities.  Soon,  howe- 
ver, it  was  understood  by  those  conversant  with  anatomy,  that 
these  accidental  injections  of  the  lymphatics  did  not  prove  the 
lymphatics  to  take  their  origin  either  lrom  the  cells  or  from  the 
extreme  arteries  ; but  already  this  good  effect,  at  least,  was 
produced,  that  men’s  minds  were  excited  to  inquire  after  new 
facts  and  trains  of  observations.  It  was  now  recollected,  that 
a strict  analogy  and  correspondence  subsisted  betwixt  the  lym- 
phatics and  lacteals  ; the  proofs  of  the  lacteals  being  absor- 
bents, were  re-called  to  memory  ; new  proofs  of  their  being  the 
sole  absorbents  of  the  intestines  were  brought  forward ; the  na- 
ture of  the  fluids  effused  into  the  various  cavities  and  cells  of 
the  body  was  attended  to  ; and  the  conviction  followed,  that 
the  most  essential  use  of  the  lymphatic  vessels  was  to  serve  as 


* It  was  probably  Nuck  who  firft  injected  the  lymphatics  from  the  arteries. 


188 


ORIGIN  OF  THE  LYMPHATICS, 


a system  of  absorbents,  to  take  up  the  extravasated  fluids. 
They  reflected  that  to  distend  the  intestines  with  injection 
would  never  fill  the  lacteals  ; and  were  convinced  that  the  in- 
]ection  of  the  lymphatics  could  not  be  supposed  to  be  through 
the  proper  absorbing  mouths  of  these  vessels  opening  upon  tbe 
cells  ; but  rather  that  the  injection  had  entered  the  vessels  by 
the  rupture  of  their  extreme  branches.  Thus  the  theory  of  .he 
lymphatics  being  a system  of  absorbents,  came  to  rest  on  ana- 
logv,  and  the  observation  of  the  phenomena  of  the  living  body. 

The  chief  proof  of  the  lymphatic  absorption  has  been  deri- 
ved from  the  manner  in  which  the  venereal  virus  is  received 
into  the  system.  Venereal  matter  being  allowed  to  lodge  upon 
the  delicate  skin  of  the  glans  penis  or  preputium,  causes  an  ul- 
cer there.  The  matter  of  this  ulcer  is  absorbed  by  the  lym- 
phatic of  the  part  ; an  inflamed  line  is  sometimes  to  be  traced 
into  the  groin  ; and  the  lymphatic  gland  of  the  groin  receiving 
this  absorbed  matter,  inflames  and  forms  the  bubo.  Here, 
then,  is  a proof  that  the  red  veins  do  not  absorb,  and  that  lym- 
phatics do  : else  why  are  they  inflamed,  and  why  are  the  lym- 
phatic glands  inflamed  to  suppuration  ? 

We  must  observe,  however,  that  this  is  by  no  means  an  abso- 
lute proof  of  absorption  ; nor  is  there  here  unequivocal  evi- 
dence of  venereal  matter  having  been  absorbed.  Although, 
therefore,  we  believe  in  the  general  system,  we  may  hazard 
these  queries  : — If  this  matter  is  absorbed,  why  is  there  no  in- 
fection without  ulcer  (chancre)  of  the  glands  ? If  this  ulcer  be 
produced  by  absorption,  how  comes  it  that  the  constitution  is 
not  infected  by  the  first  absorption  of  the  matter,  and  before 
it  has  formed  an  ulcer  ? Is  it  not  probable  that  the;  irritation  of 
the  venereal  matter,  lodging  on  this  vascular  suriace,  and  with- 
out being  absorbed,  causes  a peculiar  inflammation,  the  tenden- 
cy of  which  is  to  form  a pustule,  and  to  produce  matter  similar 
to  that  which  originally  infected  the  part  with  the  specific  and 
peculiar  action  ? Again  it  will  be  said,  however  the  venereal 
pustule  was  originally  produced,  it  appears  evident  that  the  ab- 
sorption of  this  matter,  the  conveying  of  it  along  the  lympha- 
tic, inflames  the  vessel,  and  the  next  lymphatic  gland  into 
which  it  enters,  receiving  the  venereal  matter,  inflames  and 
suppurates,  &c.  But  again,  I choose  to  say,  with  every  show 
of  likelihood,  that  neither  is  this  a proof  of  absorption  ; but 
that  the  lymphatic  vessel  being  very  irritable,  and  always  re- 
ceiving its  stimulus  to  action  from  its  extremities,  it  has  parta- 
ken of  the  venereal  inflammation  ; that  this  inflammation  has 
been  propagated  to  the  gland  ; that,  the  gland  being  formed  of 
the  convoluted  lymphatic  vessels,  the  effect  of  this  inflammato- 
ry action  is  then  accumulated  to  so  great  a degree  as  to  destroy 


AND  OF  THE  DOCTRINE  OF  ABSORPTION. 


189 


the  function  of  the  gland  and  lead  to  suppuration.*  And  fur- 
ther, that  the  disease  is  received  into  the  constitution  only  in 
consequence  of  the  system  at  large  partaking  of  the  irritation  (a 
word  which  but  imperfectly  expresses  the  cnange)  of  the  local 
action  of  vessels.  Matter  might  be  absorbed  and  taken  into 
the  constitution,  and  the  disease  propagated  according  to  the 
common  explanation  ; but,  according  to  that  offered  here,  there 
must  be  a primary  and  local  disease,  from  which  the  general 
affection  is  propagated.  If  we  are  to  take  the  inflammation 
and  hardening  of  the  lymphatics  and  axillary  glands  as  a symp- 
tom of  absorption  from  a diseased  mamma,  we  must  acknow- 
ledge the  same  proof  in  evidence  of  the  veins  absorbing  : for 
although  the  lymphatics  are  more  active,  and  their  activity  de- 
pends on  the  state  of  their  origins  and  extreme  branches,  more 
irritable,  more  vascular  (I  will  venture  to  say,)  and  more  liable 
to  inflammation  than  the  veins  ; yet  are  the  veins  affected  in 
a waj  that  would  as  unequivocally  prove  them  to  be  absorbents, 
for  we  see  how  they  enlarge  around  a diseased  breast,  become 
prominent  and  hard,  and  lose  their  softness  and  elasticity. 
But,  as  we  would  not  say  that  this  is  a proof  of  absorption  by 
the  veins,  neither  is  the  proof  unequivocal  that  there  is  absorp- 
tion by  the  lymphatics.  Again,  a suppurating  stump,  with 
bad  inflammation,  will  cause  inflammation  of  the  lymphatics, 
and  suppuration  in  the  glands  ol  the  groin  ;f  a proof  of  ab- 
sorption of  the  matter  of  the  stump  : but  we  do  not  find  that 
from  such  a stump  the  veins  ascend,  inflamed  and  suppurating, 
while  sometimes  a chain  of  abscesses  is  formed  for  a consider- 
able extent.  This,  we  can  have  no  doubt,  is  the  effect  of  the 
inflammation  continued  along  the  vessel ; and  is  not  the  in- 
flammation produced  precisely  in  the  same  way  in  the  lym- 
phatic ? 

I found  my  opinion  of  the  lymphatics  being  absorbents, — 
first,  on  the  circumstance  that  their  structure  is  adapted  to  this 
action ; secondly,  on  the  analogy  between  them  and  the 
lacteals,  in  which  absorption  is  proved  ; thirdly  and  lastly, 
upon  their  continuing  to  receive  and  transmit  their  fluids,  after 
the  heart  and  arteries  have  ceased  to  beat,  and  the  red  blood 
to  circulate  : for  then  how  can  they  act,  but  by  their  own 
powers  ? How  can  they  receive  fluids,  but  by  absorption  ? 
Finally,  this  phenomenon  shows  in  the  lymphatics,  a greater 

* If  a chancre  be  indolent,  although  matter  be  formed  in  it,  no  bubo  will  be 
produced : but  if  the  furgeon  applies  fome  corrofive  dreffing,  which,  inftead  of 
entirely  deftroying  the  difeafed  fpot,  inflames  it,  then  will  the  gland  in  the  groin 
fympathife  and  rife  into  a bubo. 


t See  Hunter’s  Commentaries. 


190 


OF  THE  ABSORPTION  OF  SOLIDS. 


degree  of  irritability,  and  stronger  principle  of  activity  and 
tenacity  of  life,  than  actuates  any  other  set  of  vessels. 

OF  THE  ABSORPTION  OF  SOLIDS. 

On  examining  the  works  which  within  the  last  forty  years 
have  contributed  to  throw  light  on  this  subject,  we  at  once 
acknowledge  how  necessary  it  is  for  that  part  of  a systematic 
book  of  anatomy,  which  professes  to  treat  of  absorption,  to 
take  the  form  of  a critical  inquiry.  When  the  absorption  of 
the  fluids  of  the  cellular  substance,  or  in  the  cavities,  was 
universally  assented  to,  physiologists  did  not  make  sufficient 
distinction  betwixt  the  absorption  of  the  fluid  thrown  out  of  the 
influence  of  the  circulating  vessels,  and  that  matter  which 
continued  to  be  involved  in  the  membranes  and  vessels,  and 
which  formed  the  solid  part  of  our  frame.  It  will  readily  be 
allowed  that  the  fluid  thrown  out  upon  the  surfaces  of  the  body 
and  in  the  cells,  might  be  absorbed  without  inferring  that 
every  part  of  the  body,  solids  and  fluids,  were  also  taken  up 
by  the  lymphatic  absorbent  vessels.  But  physiologists  observ- 
ing that  the  solid  parts  of  the  body  were  suffering  perpetual 
change  ; that  the  whole  body  and  the  vessels  themselves  were 
formed,  decomposed,  and  carried  away  ; they  hesitated  not 
to  attribute  this  to  the  deposition  from  the  arteries,  and  the  ab- 
sorption by  the  lymphatics.  This  alternate  destruction  and 
renovation  of  parts,  the  perpetual  change  which  the  whole 
body  suffers,  has  been  universally  acknowledged  and  attributed 
in  part  to  the  operation  of  the  lymphatic  system,  without  any 
other  proof  than  a slight  analogy. 

The  interstitial  fluids,  and  the  fluid  in  the  cavities,  is  im- 
bibed by  the  absorbing  mouths  of  the  lymphatics  on  the  sur- 
face of  the  membranes  ; but  where  is  the  analogy  between 
this  and  the  destruction  of  solid  parts  ? It  has  been  said  that 
the  absorbents  eat  down  the  solids,  and  nibble  like  the  mouth 
of  a worm!  a conjecture,  the  falsity  of  which  is  equal  to  its 
apparent  absurdity.  The  solids  are  raised  by  the  agency  of  the 
vessels  on  the  chemical  affinities  of  the  circulating  fluids. 
They  must  be  resolved  by  their  decomposition,  reducing  them 
again  to  the  state  of  fluids  ; or  the  secreting  vessels  throw  out 
fluids  which  dissolve  them  : an  operation  anterior  to  their  ab- 
sorption. From  the  comparative  simplicity  of  the  fluids  of 
the  circulating  vessels,  and  that  in  the  absorbents,  we  are  au- 
thorized to  conclude,  that  as  from  the  blood  the  several  secre- 
tions, solids,  and  fluids  are  formed  ; these  fluids,  before  they 
are  again  taken  into  the  active  system  of  vessels,  are  resolved 
into  their  original  simple  and  constituent  parts.  Thus  we  are 


OF  THE  ABSORPTION  OE  SOLIDS. 


191 


not  to  look  for  the  matter  of  the  component  parts  of  the  body 
in  the  absorbing  system  of  vessels  more  than  in  the  blood,  from 
which  these  parts  were  originally  formed. 

Upon  this  subject  I conceive,  that  the  absorption  of  the 
solids  depends  but  in  a limited  degree  on  the  agency  of  the 
lymphatics  ; and  that  there  is  a necessary  change  in  the  aggre- 
gation of  the  matter  previous  to  the  absorption  by  the  mouths 
of  the  lymphatic  vessels. 


EXAMINATION  OF  SOME  OPINIONS  OF  MR.  HUNTER  ON  THE 
SUBJECT  OF  ABSORPTION  OF  SOLIDS. 

Mr.  Hunter  says  that  his  conception  of  the  matter  is,  that 
nature  leaves  little  to  chance  ; and  that  the  whole  operation  of 
absorption  is  performed  by  an  action  in  the  mouths  of  the  ab- 
sorbents. Physiologists  have  laboured,  he  observes,  to  ex- 
plain absorption  on  the  principle  of  capillary  attraction,  be- 
cause it  was  familiar  ; but  as  they  were  still  under  the  necessity 
of  supposing  action  in  the  vessels  after  the  matter  was  absorb- 
ed, they  might  as  well  have  carried  this  action  to  the  mouths 
of  these  vessels. 

One  never  could  have  ventured  to  suppose  the  extravagant 
conclusion  to  which  this  idea,  once  entertained,  has  led  Mr. 
Hunter. — He  proceeds  to  consider  the  many  kinds  of  solids 
the  lymphatics  have  to  carry  away,  and  the  variety  of  mouths 
in  different  animals,  suited  to  the  great  variety  of  substances 
they  have  to  work  upon,  and  then  draws  the  conclusion,  or 
leaves  his  reader  to  do  so  ; that  not  only  are  the  mouths  of  the 
lymphatics  calculated  to  absorb  fluids  ; not  only  do  they  carry 
away  the  solids,  but  each  vessel,  according  to  the  hardness  and 
toughness  of  the  material  upon  which  it  has  to  operate,  has  a 
mouth  adapted  for  the  work.  Here  we  do  not  see  the  genius 
of  Hunter,  but  a poverty  of  imagination. 

Mr.  Hunter  takes  the  merit  of  a new  doctrine  relating  to 
absorption. — He  admits  that  oil,  fat,  and  earth  of  bones  had 
always  been  considered  as  subject  to  absorption  ; and  that  some 
other  parts  of  the  bodv,  liable  to  waste  had  been  supposed  to 
suffer  by  absorption  ; but  that  any  solid  part  should  be  absorb- 
ed, he  supposes  to  be  entirely  a new  doctrine. — Now,  I think 
we  may  venture  to  affirm,  that  not  only  was  it  known  that  solid 
parts  of  the  body  were  taken  away  during  life  ; but  that  physi- 
ologists knew  each  and  every  part  of  the  living  body  to  be  un- 
dergoing a perpetual  decay  and  renovation.  Nay,  we  may 
venture  further  to  say,  that  Mr.  Hunter  did  not  comprehend, 
in  its  full  extent,  the  relation  in  which  the  secreting  and  absorb- 


192 


OF  THE  ABSORPTION  OF  SOLIDS. 


ing  vessels  stand  to  each  other.  He  is  fond  of  calling  the  ab- 
sorbents, modellers — u modellers  of  the  original  construction 
of  the  body,” — “modellers  of  the  form  of  the  body  while 
growing.”  No  doubt  he  understood  that  such  terms  from 
their  novelty  would  be  acceptable  to  minds  incapable  of  real 
conviction,  or  of  receiving  or  appreciating  a new  fact  or  idea. 
Mr.  Hunter  could  contemplate  no  change  in  the  body  during 
growth,  decay,  or  disease,  where  there  was  an  alteration  of 
form  or  quantity  of  matter,  without  attributing  it  to  the 
“ modelling  absorption.” — A bone  cannot  lie  removed  without 
absorption  ; nor  a part  which  is  useless  to  the  ceconomy  (as  the 
alveoli  of  the  teeth,  the  ductus  arteriosus,  the  membrana 
pupillaris,  the  thymus  gland)  diminished  in  size  or  totally  car- 
ried away,  without  the  absorbents  being  in  action.  This  is 
undoubtedly  true  ; but  in  regard  to  the  manner  in  which  it  is 
performed  we  cannot  agree  with  Mr.  Hunter.  When  it  be- 
comes necessary  that  some  part  should  be  removed,  it  is  evi- 
dent that  nature,  in  order  to  effect  this,  must  not  only  confer  a 
new  activity  on  the  absorbents,  but  must  throw  the  part  to  be 
absorbed  into  such  a state  as  to  yield  to  this  operation.  This 
is  the  only  animal  power  capable  of  producing  such  effects  ; 
and  like  all  other  operations  of  the  machine,  it  arises  from 
stimulus  or  irritation,  &c.  Now,  this  appears  to  be  the  fun- 
damental error  of  Mr.  Hunter’s  doctrine.  I conceive  that  the 
absorption  of  parts  in  the  natural  action  of  health  or  in  disease, 
is  not  owing  to  increased  stimulus,  but  often  to  a diminution 
of  it. 

Does  it  not  strike  us  forcibly  that  when  a gland  swells,  and 
leeches  and  blisters  are  applied,  and  it  subsides,  there  can  be 
no  means  of  exciting  absorption  ; that  when  pressure  is  made 
on  a part,  and  that  part  is  absorbed,  this  is  a strange  way  of 
stimulating?  Or  when  we  bleed,  is  it  not  odd  that  this  should 
give  new  power  to  the  lymphatic  system  ? for  these  are  the 
means  of  giving  a counter  irritation,  and  of  suppressing  action. 

Mr.  Hunter  has  given  to  the  lymphatics  not  only  the  grovel- 
ling qualities  of  animals,  as  eating ; but  the  higher  attributes 
of  intellect.  They  do  nothing  without  forethought  and  inten- 
tion ; when  they  absorb,  it  is  because  they  have  found  the 
parts  useless  in  the  oeconomy.  He  has  carried  this  notion  so 
far,  that  he  does  not  only  speak  of  the  absorption  of  the  thy- 
mus gland,  membrana  pupillaris,  alveoli  of  the  teeth,  &c. 
but  of  the  body  in  fever  as  a consequence  of  its  becoming  use- 
less when  under  disease  ! — The  following  may  perhaps  appear 
to  be  the  more  natural  supposition  : 

In  a living  body  we  may  observe  the  agency  of  the  nervous, 
vascular,  and  absorbing  systems  : and  the  phenomena  of  life 


OF  THE  ABSORPTION  OF  SOLIDS. 


193 


are  not  to  be  attributed  to  any  one,  but  to  the  whole  of  these. 
We  must  also  observe,  that  life,  or  the  mutual  action  of  parts 
producing  the  phenomena  of  life,  is  proceeding  from  excite- 
ment, and  as  in  the  whole  system,  so  in  the  individual  parts  of 
the  bod}',  the  healthy  action  depends  on  the  influence  of  this 
excitement  to  action.  The  tendency  of  the  growth  of  the 
body  to  peculiar  forms,  and  the  increase  of  parts  in  disease 
are  produced  by  it.  It  acts  upon  the  vascular  system  in  dis- 
ease, by  producing  increased  action  and  secretion  ; as  a mus- 
cle, in  the  use  of  frequent  and  strong  action,  will  become 
more  fleshy  and  vascular ; as  a gland,  will  be  excited  to  greater 
action  and  more  profuse  discharge,  whilst  it  enlarges  and 
swells  up.  When  a part  enlarges  in  consequence  of  the  stimu- 
lus to  increased  action,  either  arising  from  the  natural  law  of 
the  constitution  or  from  disease,  it  proceeds  from  the  secreting 
vessels  preponderating  over  the  absorbing  vessels.  There  is  a 
deposition  of  matter  which  the  latter  are  unable  to  take  away. 
But  diminish  this  action  of  the  arteries,  or  take  away  their  ex- 
citement, or  cause  an  excitement  of  some  neighbouring  part, 
and  thereby  subdue  their  action,  relieve  them  of  their  fulness, 
and  the  absorbents  regain  their  proportioned  actions,  and  the 
part  subsides.  The  parts  of  the  body,  which,  in  the  natural 
changes  from  youth  to  age,  are  absorbed  and  carried  away, 
are  those  in  which  there  is  no  longer  the  stimulus  to  vigorous 
action,  and  of  course  the  lymphatics  preponderate  over  the 
power  of  the  secreting  vessels,  and  the  part  gradually  dimin- 
ishes, loses  its  apparent  vascularity,  loses  its  redness,  and  is  at 
last  totally  absorbed.  And  as  the  tooth  of  a child  lies  long  hid 
under  the  jaw,  where  it  partakes  of  the  stimulus  to  the  action 
of  its  vessels,  grows  and  rises  up,  and  the  alveoli,  partaking 
of  this  natural  excitement,  also  form  around  it  ; so  when  the 
tooth  decays  and  falls  out,  the  alveoli  will  also  decay  and  be  ab- 
sorbed ; because  the  moment  these  vessels  have  ceased  to  par- 
take of  the  increased  action,  their  absorbents,  though  acting 
with  no  greater  powers  than  formerly,  do  yet  so  preponderate, 
that  a gradual  wasting  is  the  consequence.  Thus  we  have  to 
consider  not  the  action  of  the  absorbents  merely,  but  the  rela- 
tion which  their  action  has  to  that  of  the  arteries. 

I should  conclude  that  a part  which  has  ceased  to  be  of  use 
in  the  oeconomy  and  is  absorbed,  has  not  been  carried  away  by 
the  stimulus  applied  to  the  modelling  lymphatics  ; but  in  con- 
sequence of  a want  of  the  usual  excitement  of  the  parts  to 
action,  and  of  the  consequent  preponderance  of  the  action  of 
the  lymphatics  ; not  by  an  increase  of  their  action,  but  by  a 
greater  uniformity  of  action,  less  dependent  on  the  state  of  ex- 
citement of  the  part.  This  more  uniform  state  of  action,  or 
Vol.  IV.  2 B 


i94 


OF  THE  ABSORPTION  OF  SOLIDS. 


lesser  degree  of  dependence  on  excitement,  will  not  be  denied 
when  we  see  them  continuing  their  action  after  the  death  of 
the  animal,  and  alter  the  other  phenomena  of  life  have  ceased. 
As  to  the  absorption  of  the  body  in  general  from  disease,  as 
in  fever,  it  appears  to  be  simply  the  effect  of  the  continued  ab- 
sorption, while  neither  the  organs  for  digesting  and  assimilat- 
ing new  matter,  nor  the  vascular  system  for  conveying  the 
fluids,  are  in  a state  to  minister  to  the  wants  of  the  system, 
but  suffer  under  an  unusual  irritation,  which  disorders  then- 
function. 

As  to  pressure  causing  absorption  and  producing  the  wast- 
ing of  parts,  I cannot  agree  with  Mr.  Hunter  in  supposing 
that  the  lymphatics  are  here  excited  to  action ; but  should 
rather  infer  that  the  nerves  of  the  parts  being  benumbed, 
and  the  action  of  the  arteries  suppressed,  the  lymphatics  con- 
tinue to  do  their  office,  while  the  arteries  are  prevented  from 
depositing  new  matter. — -For  example,  when  we  see  a curva- 
ture of  the  spine,  from  a habitual  inclination  of  the  body  to 
one  side,  and  consequently  greater  pressure  on  the  one  side 
of  the  bodies  of  the  vertebra  : it  is  natural,  at  first  sight,  to  say, 
since  the  one  side  of  the  vertebra  is  of  its  natural  depth,  and 
the  other  diminished,  that  the  side  which  is  deep  has  remain- 
ed, but  the  other  side  has  been  absorbed  ; but,  when  we  in- 
quire a little  deeper  into  the  phenomenon  which  has  taken 
place,  we  recollect  that  the  matter  of  bone  is  undergoing  a per- 
petual change,  and  that  the  matter  of  both  sides  of  the  verte- 
bra is  changed  ; we  see  that  the  pressure  may  not  have  excit- 
ed the  vessels  to  greater  action  so  as  to  cause  absorption  ; but 
that  the  pressure  has  prevented  the  deposition  of  new  matter, 
whentheold  was  taken  away  in  the  natural  routine  of  the  system. 

Mr.  Hunter  has  assigned  five  causes  of  absorption,  which  f 
conceive  may  be  very  naturally  resolved  into  one. — These  are, 
1,  parts  being  pressed  ; 2,  parts  being  irritated  ; 3,  parts  being 
weakened  j 4,  parts  being  rendered  useless  ; 5,  parts  becoming 
dead  : of  the  first  we  have  already  spoken  ; the  second  I should 
deny,  unless  when  it  resolves  into  the  third  ; for  irritation 
does  not  cause  absorption,  unless  when  it  is  to  an  extent  suf- 
ficient to  destroy  the  natural  action  and  weaken  the  part. 
The  third  and  fourth  come  under  the  effect  of  the  loss  of  the 
natural  and  accustomed  stimulus  to  action  in  the  arterial  sys- 
tem, which  of  course  gives  a preponderance  to  the  absorbents  : 
of  the  fifth  we  can  have  nothing  to  add  illustrative  of  the  liv- 
ing system. 


( 195  ) 


CHAP.  II. 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


The  lymphatics,  in  their  course  and  relation  to  the  fascia  and 
muscles  of  the  extremities,  bear  a great  analogy  to  the  veins  j 
for  there  are  two  sets  or  grand  divisions, — the  deep  lympha- 
tics which  accompany  the  arteries  in  their  branchings  a- 
mongst  the  muscles  ; and  the  superficial  set  which  accom- 
pany the  external  veins. 


SECTION  I. 


Of  the  foot,  leg,  and  thigh.  Even  in  the  toes  the 
same  distinction  of  the  origins  of  the  lymphatics  may  be  ob- 
served, as  in  the  limb.  For  while  a plexus  covers  the  toes 
superficially,  and  runs  up  upon  the  foot  with  the  veins,  deep- 
er branches  accompany  the  arteries  on  the  side  of  the  toes. 
When  we  observe  the  course  and  origins  of  the  greater  and 
lesser  saphena  vein,  we  cannot  fail  to  understand  the  course 
of  the  several  sets  or  divisions  of  the  lymphatics  of  the  foot 
and  legs. 

From  the  toes,  dorsum,  and  edges  of  the  foot,  the  lympha- 
tics climb  up  the  leg  in  four  classes.  1.  One  takes  a course 
from  the  root  of  the  great  toe  and  inside  of  the  foot,  over  the 
tendons  of  the  great  toe  and  tibialis  anticus  tendon.  It  then 
passes  on  the  inside  of  the  tendon  of  the  tibialis  anticus  mus- 
cle, and  before  the  head  of  the  tibia,  following  the  principal 
branch  of  the  great  saphena  vein  ; and  then  continues  its 
course  in  company  with  the  saphena  to  the  inside  of  the  knee. 
2.  There  is  at  the  same  time  a considerable  number  of  lym- 
phatics, taking  their  origin  from  nearly  the  same  place,  viz. 
the  inside  of  the  foot,  and  before  the  inner  ankle  ; but  they 
take  a different  course  on  the  leg  from  the  last  class  ; for  they 
pass  behind  the  lower  head  of  the  tibia : they  now  attach  them- 
selves to  some  branch  of  the  saphena  vein,  and  join  the  for- 
mer set  on  the  inside  of  the  knee.  From  this  they  ascend 


196 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


superficially  above  the  fascia  to  the  glands  of  the  groin.  S. 
From  the  outside  of  the  foot  there  ascend  several  lymphatics  ; 
a division  of  which  passes  before  the  outer  ankle  and  across 
the  tibia  to  join  the  lymphatics,  parasites  of  the  greater  saphena 
vein,  and  here  they  sometimes  form  plexus  and  contortions  ; 
others  turn  in  behind  the  outer  ankle,  and  join  the  branches 
accompanying  the  lesser  saphena. 

The  lymphatics  which  turn  round  behind  the  outer  ankle 
pass  on  the  outside  of  the  tendo  achillis  ; and  accompanying 
the  lesser  saphena  vein,  sink  into  the  popliteal  hollow.  Here 
they  unite  with  the  lymphatics  which  have  accompanied  the 
several  arteries  of  the  leg  and  foot,  and  particularly  the  pos- 
terior tibial  artery. 

Popliteal  glands.  The  glands  of  the  ham-string  cavity 
are  generally  three  in  number,  and  very  small.  They  receive 
the  lymphatics,  which  pass  with  the  internal  tibial  artery  and 
with  the  lesser  saphena,  stnd  they  of  course  swell  and  become 
inflamed  in  consequence  of  sores  on  the  calf  of  the  leg,  outside 
of  the  foot,  and  sole  of  the  foot. 

From  the  popliteal  glands  there  ascend  two  large  lymphatics, 
which  accompany  the  popliteal  artery  and  venae  comites,  and 
ascend  with  the  latter  through  the  adductor  magnus  to  the  fore 
part  of  the  thigh.  They  run  irregularly,  or  form  a kind  of" 
network  round  the  great  vessels.  On  the  fore  part  of  the  thigh, 
and  still  deep,  they  (or  at  least  some  of  the  principal  trunks) 
enter  the  lower  and  deep  inguinal  glands,  or  emerging,  they 
pass  into  the  outward  glands  of  the  groin.  Sometimes  these 
deep  lymphatics,  instead  of  being  accumulated  into  larger 
trunks,  divide  into  many  branches,  and  only  unite  in  the 
glands  of  the  groin. 

Inguinal  glands.  The  inguinal  glands  are  in  number 
from  five  to  ten  ; they  lie  involved  in  cellular  membrane  on  the 
outside  of  the  femoral  ligament.  Some  of  them  are  superficial 
and  moveable  under  the  integuments  ; some  involved  in  the 
laminae  of  the  fascia,  descending  from  the  abdominal  muscles  ; 
some  are  close  on  the  femoral  artery  and  vein,  and  under  the 
fascia.  Nearer  to  the  pubes  may  be  observed  a division  of 
these  glands  which  belong  to  the  lymphatics  of  the  penis,  pe- 
rineum, &c. 

The  greater  cluster  of  glands  on  the  top  of  the  thigh  be- 
come affected  from  disease  of  the  integuments  on  the  fore 
part  and  inside  of  the  thigh  and  leg ; and  of  that  part  of  the 
foot  where  the  great  saphena  vein  commences  ; nay,  further, 
the  inguinal  glands  swell  from  sores  of  the  buttocks,  about  the 
anus  and  private  parts.  They  will  even  swell  from  disease  of 
the  testicle  ; but  this  only  by  sympathy. 


OF  THE  COtfRSE  OF  THE  LYMPHATICS* 


19  7 


Lymphatics  of  the  parts  of  generation  in  both  sex- 
es. From  the  penis  there  run  backwards  two  sets  of  lympha- 
tics : superficial  ones,  which  take  a course  to  the  groin  ; and 
deeper  ones,  which  take  a course  along  the  arteries  of  the  penis 
into  the  pelvis,  or  under  the  arch  of  the  pubes.  The  superficial 
lymphatics  are  the  cutaneous  vessels,  and  take  their  origin  from 
the  prepuce,  and  it  is  these  which,  either  absorbing  the  vene- 
real matter  of  chancre,  or  sympathizing  with  the  venereal  ac- 
tion, form  sometimes  an  inflamed  line  along  the  penis,  and 
cause  the  bubo  in  the  groin.  But  as  there  are  two  sets  of  lym- 
phatics, the  chancre  may  be  in  a place  where  the  deep-seated 
vessels  are  the  absorbents,  and  consequently  the  constitution  is 
comaminated  without  any  bubo  in  the  groin ; and  indeed  it  has 
been  observed,  that  a venereal  ulcer  of  the  prepuce  will,  in  ge- 
neral, produce  bubo,  when  an  ulcer  of  the  glands  will  not.* 
When  the  tract  of  the  matter  is  through  the  deep  lymphatics 
which  enter  the  pelvis  from  below,  th^gland  through  which 
the  vessels  pass,  is  not  inflamed  to  form  a bubo  ; neither  do 
the  lymphatic  glands  within  the  ligament  of  the  thigh  inflame 
to  the  extent  or  forming  a bubo,  either  from  chancre  orfrom  bubo 
in  the  groin.  This,  says  a celebrated  anatomist,  Mr.  Cruick- 
shanks,  is  very  fortunate  ; for  if  the  external  iliac  glands,  like 
the  inguinal  glands,  should  suppurate,  they  could  not  be  open- 
ed by  the  lancet,  they  must  be  left  to  themselves  ; they  might 
burst ; the  pus  might  fall  into  the  cavity  of  the  abdomen  ; 
might  produce  peritoneal  inflammation  ; and  might  probably 
destroy  the  patient.  Now,  there  appears  no  reason  to  dread 
any  such  catastrophe.  The  matter  of  these  glands  would  form 
an  abscess,  which,  like  other  abscesses  in  the  track  of  these  ves- 
sels, would  fall  down  upon  the  thigh.  The  fact,  however,  is 
curious  ; that  when  the  lymphatics  diseased  enter  one  set  of 
glands,  there  will  be  no  bubo  ; when  they  take  a course  to  the 
other,  they  inflame  and  suppurate.  This  I believe  may  be  ex- 
plained, from  considering  the  position  of  the  inguinal  glands, 
as  being  immediately  under  the  skin  : for  experience  shows 
that  a part  near  the  surface  will  inflame  and  proceed  to  suppu- 
ration much  more  readily  than  a part  deep  seated,  though  suf- 
fering from  the  same  degree  of  excitement. 

In  the  external  parts  of  woman  (by  Mr.  Cruickshanks’s  ob- 
servation) there  are  also  two  sets  of  lymphatics.  Those  near 
the  clitoris  pass  up  in  a direction  to  the  ring;  and  those  from 
the  lower  part  of  the  vulva  and  perineum  to  the  glands  of  the 
groin. 

Lymphatics  and  glands  within  the  ligament  of  the 


Croickfhanks,  page  138. 


198  OF  THE  COURSE  OF  THE  LYMPHATICS. 

thigh.  The  vasa  efferentia  of  the  inguinal  glands  are  in  num- 
ber from  two  to  six.  The  deep  lymphatics  which  accompany 
the  femoral  vein  and  artery,  lying  under  the  cellular  membrane, 
pass  under  the  ligament,  and  soon  form  a large  net- work  of  ves- 
sels accompanying  the  iliac  vessels,  in  which  they  are  joined  by 
the  branches  of  lymphatics  from  the  superficial  glands  ; some- 
times the  trunks  accompanying  the  great  vessels  of  the  thigh 
pass  into  a gland,  immediately  within  the  ligament ; sometimes 
one  or  two  of  them  only  enter  into  the  glands  high  in  the  loins  ; 
nay,  sometimes  a large  vessel  passes  on  directly  to  the  thoracic 
duct. 

From  six  to  eight  or  ten  glands  are  seated  in  the  tract  of  the 
external  iliac  vessels  under  the  name  of  external  iliac 
glands.  And  upon  the  inside  of  the  brim  of  the  pelvis,  and 
on  the  hypogastric  vessels,  the  glands  are  called  the  internal 
iliac  glands.  In  proportion  to  the  frequency  of  disease  in 
the  pelvis,  these  external  iliac  glands,  being  in  the  tract  of  the 
lymphatics  of  the  private  parts  and  rectum,  See.  are  particular- 
ly subject  to  disease.  Those  glands  also  which  are  called  sa- 
cral glands,  as  lying  on  the  meso-rectum,  and  in  the  hollow 
of  the  sacrum,  have  been  observed  to  be  often  diseased.  On 
the  psoas  muscle,  and  on  the  loins  it  is  impossible  to  trace  the 
vessels  as  single  trunks  ; we  may  observe  that  one  net-work  of 
vessels  ascends  upon  each  psoas  muscle  from  the  thigh  ; that 
there  it  is  joined  by  the  lymphatics  of  the  pelvis.  These  ves- 
sels are  in  a manner  united  by  those  which  cover  the  prominen- 
cy of  the  sacrum,  and  pass  under  the  bifurcation  of  the  aorta. 
The  two  great  lumbar  plexus  of  lymphatics  continuing  their 
ascent,  many  of  the  vessels  enter  into  the  lumbar  glands  ; and 
on  the  loins  they  are  joined  by  the  absorbents  of  the  testicle. 
By  the  union  of  the  lymphatics  ascending  from  the  right  and 
left  side,  with  several  large  trunks  of  the  lacteals  from  the  root 
of  the  mesentery,  the  thoracic  duct  is  formed  on  the  third  and 
fourth  vertebra  of  the  loins. 

OF  THE  LYMPHATICS  OF  THE  ARM. 

In  the  arm,  as  in  the  leg  and  thigh,  there  are  two  sets  of 
lymphatics  : — the  superficial,  and  deep  seated.  The  first  of 
these  accompany  the  cutaneous  veins,  the  latter  the  deep  arteries. 

As  in  general  there  are  two  great  veins  on  the  fore-arm,  the 
basilic  and  cephalic  veins  ; but  particularly  as  the  veins  which 
gather  into  the  basilic  trunk,  on  the  inner  and  lower  edge  of  the 
fore-arm,  are  the  larger  and  more  numerous  class  ; so  it  is 
found  that  the  course  of  the  more  numerous  class  of  lympha- 
tics is  on  the  lower  and  inner  side  of  the  fore-arm,  and  that 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


199 


they  accumulate  about  the  basilic  vein.  These  are  derived 
from  the  palm  of  the  hand,  and  from  the  ulnar  edge  of  the 
hand.  This  set  sometimes  passes  into  glands,  seated  on  the 
brachial  artery,  near  the  inner  condyle  of  the  humerus. 

The  absorbents  which  accompany  the  cephalic  vein,  arise 
from  the  sides  of  the  thumb  and  fore  finger  upon  the  back  of 
the  hand  ; they  run  on  the  radial  edge  of  the  arm,  with  the 
veins  which  ascend  to  form  the  cephalic  vein.  From  the  bend 
of  the  arm  these  vessels  take  a course  on  the  outer  edge  of  the 
biceps,  and  then  get  betwixt  the  inner  edge  of  the  deltoid,  and 
outer  edge  of  the  pectoral  muscles  ; they' then  pass  under  the 
clavicle,  and  descend  into  the  axillary  glands.  This  set  of  ab- 
sorbents receive  the  branches  from  the  outside  of  the  arm  in 
their  whole  course. 

There  are  absorbents  arising  from  the  back  of  the  hand, 
next  the  little  finger,  which  following  some  of  the  branches  of 
the  basilic  vein  (a  larger  branch  of  which  is  called  the  ulnaris 
externa)  turn  round  the  ulnar  edge  of  the  arm,  are  inserted 
into  a gland,  very  commonly  found  before  and  a little  above 
the  inner  condyle  of  the  humerus.  From  this  gland  a large 
lymphatic  passes  upwards,  and  attaching  itself  to  the  brachial 
artery,  splits  and  plays  around  it. 

The  deep-seated  lymphatics  of  the  arm  accompany  the  ar- 
teries in  the  same  manner  as  the  venae  comites  do  ; in  general 
two  with  each  artery.  They  all  terminate  in  the  glands  of  the 
axilla,  and  can  require  no  particular  description.  The  lym- 
phatics, from  the  muscles  and  integuments  on  the  back  of  the 
shoulder,  also  turn  round  and  enter  into  the  glands  of  the 
axilla. 

The  glands  of  the  arm  are  small,  and  irregularly  placed 
in  the  course  of  the  humeral  artery,  from  the  condyle  to  the 
axilla.  They  are  from  three  to  six  in  number. 

The  glands  of  the  axilla  are  large  and  numerous  ; 
they  receive  the  lymphatics  from  the  arm,  breast,  and 
shoulder  they  lie  in  the  deep  cavity  of  the  axilla,  formed  by 
the  tendons  of  the  pectoralis  major,  and  latissimus  dorsi  mus- 
cles. They  are  imbedded  in  a loose  cellular  membrane,  which, 
while  it  surrounds  and  supports  the  vessels  of  the  axilla  in  the 
motions  of  the  joint,  gives  them  strength  from  its  elasticity. 
These  glands  do  not  all  surround  the  axillary  artery  ; but  a 
lower  cluster  is  attached  to  the  branches  of  the  subscapular  ar- 
tery, going  forward  on  the  side  of  the  chest,  and  to  the  thora- 

* “ They  even  receive  abforbents  from  the  cavity  of  the  cheft,  and  I have 
known  them  fwell  from  pleunfy,  peripneumony,  and  pulmonary  confumption.’’ 
Gruickfhanks, 


200 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


cic  arteries.  These  it  is  which,  indurating  from  cancer  of  the 
breast,  require  so  frequently  to  be  extirpated.  These  glands 
of  the  axilla  greatly  enlarging  close  upon  the  artery  and  plexus 
of  nerves,  so  as  to  preclude  the  possibility  of  an  operation  ; 
they  compress  the  veins  and  benumb  the  arm  by  pressure  upon 
the  nerves.  When  they  suppurate,  they  cause  a condensation 
of  the  cellular  membrane  which  surrounds  them,  and  in  con- 
sequence, a compression  of  the  axillary  nerves  and  a shrink- 
ing of  the  arm. 

When  a wound  or  puncture,  such  as  that  which  the  student 
of  anatomy  may  receive  in  the  dissecting  room,  has  b^en  made 
on  the  little  or  ring  finger,  the  red  lines  which  often  appear  in 
consequence  of  it,  have  taken  the  course  of  the  ulnar  edge  of 
the  fore-arm,  and  terminated  in  the  inside  of  the  arm,  near 
the  condyle  ; in  some  instances  they  have  been  continued  even 
into  the  axilla.  If  venereal  matter  is  absorbed  at  any  point  of 
the  hand,  near  the  little  or  ring  finger,  or  by  those  fingers,  the 
gland  on  the  inner  condyle  ol  the  humerus,  or  some  one  in  the 
course  of  the  brachial  artery,  will  most  probably  inflame  and 
form  a bubo,  and  the  surgeon  will  be  aware  of  this  absorption  ; 
but  if  the  venereal  matter  be  absorbed  on  the  thumb  or  fore- 
finger, it  is  possible  that  it  may  not  pass  into  the  glands  until  it 
comes  into  the  inside  of  the  clavicle.  These  glands  being  out  of 
our  sight  and  feeling,  the  patient  may  be  infected  without  the 
surgeon  suspecting  it.^ 

LYMPHATICS  OF  THE  HEAD  AND  NECK. 

Of  the  absorbents  of  the  brain,  little  is  known  precisely  ; 
but  none  can  deny  the  probability,  next  to  an  absolute  assur- 
ance and  demonstration,  that  the  arteries,  veins,  and  lymphatics 
bear  the  same  relations  in  the  brain  as  in  the  other  parts  of  the 
system.  Lymphatic  glands  are  observed  in  the  course  of  the 
internal  jugular  vein,  and  even  in  the  foramen  caroticum, 
which  are  understood  to  belong  to  the  lymphatics  of  the  brain. 
The  lymphatics  of  the  head  are  to  be  observed  in  the  course  of 
the  temporal  and  occipital  arteries,  which  last  terminate  in 
glands,  seated  behind  the  mastoid  process  of  the  temporal 
bone.  The  lymphatics  of  the  face  have  been  observed  very 
numerous  accompanying  the  facial  and  temporal  arteries.  But 
those  from  the  internal  parts  of  the  face  and  nose  accompany 
the  internal  maxillary  artery,  and  fall  into  the  glands  under  the 
parotid,  or  in  the  course  of  that  artery.  These  glands  are 
consequently  liable  to  disease,  in  consequence  of  absorption  of 


Cruickfhanks,  p.  182. 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


201 


matter  from  the  face,  throat,  and  nose,  and  their  extirpation 
is  a very  hazardous  operation.  The  lymphatics  from  the  gums 
and  jaws  also  accompany  the  internal  maxillary  artery,  and 
emerge  under  the  angle  of  the  jaw;  and  some  of  them  joining 
the  external  jugular  vein,  pass  through  glands  near  the  top  of 
the  shoulder.  The  lymphatic  vessels  from  the  tongue  and 
parts  about  the  os  hyoides,  take  also  the  same  course.  The 
glands  about  the  face  and  jaws  are  of  the  greatest  impor- 
tance to  the  surgeon,  for  nothing  is  more  common  than  the 
necessity  of  cutting  out  indurated  lymphatic  glands.  These 
are  sometimes  mistaken  for  diseased  salivary  glands  ; now  the 
salivary  glands  are  rarely  diseased,  the  lymphatic  glands  often . 
And  it  will  be  a guide  to  the  surgeon  to  inquire  into  the  origi- 
nal cause  of  the  induration,  (perhaps  a suppuration  in  the  throat, 
nose,  or  jaws)  and  to  know  precisely  the  gland  diseased,  its 
depth,  and  connections. 

On  the  side  of  the  face,  there  are  in  general  several  small 
lymphatic  glands  on  the  buccinator  muscle  immersed  in  the 
surface  of  the  parotid  gland,  under  the  zigomatic  process. 
There  are  also  glands  to  be  carefully  noted,  which  lie  under 
the  tip  of  the  parotid  gland,  where  it  extends  behind  the  angle 
of  the  jaw,  and  also  lying  under  the  base  of  the  jaw-bone, 
close  to  the  sub-maxillary  gland,  and  on  the  course  of  the 
facial  artery. 

The  glands  and  absorbents  of  the  neck  are  very  numer- 
ous, and  the  latter  form  an  intricate  and  beautiful  plexus, 
several  branches  of  which  are  to  be  observed  accompanying 
the  external  and  internal  jugular  veins.  Some  of  the  glands 
lie  immediately  under  the  skin,  and  in  the  cellular  membrane, 
on  the  outer  edge  of  the  platisma  mvoides  ; many  under  that 
muscle,  and  in  the  course  of  the  external  jugular  vein.  But 
there  are  many  seated  deep,  for  the  greater  number  accompany 
the  internal  carotid  artery,  and  internal  jugular  vein  or  then- 
branches. 

The  lymphatics  of  the  thyroid  gland  have  been  raised  by 
Mr.  Cruickshanks,  by  plunging  a lancet  at  random  into  the 
substance  of  the  gland,  and  blowing  into  it,  or  throwing  quick- 
silver into  its  cellular  membrane.  The  trunks  of  these  lym- 
phatics join  the  thoracic  duct  on  the  left  side  ; and  on  the  right 
side  the  right  trunk,  just  as  it  is  about  to  enter  into  the  veins. 


of  the  trunks  of  the  absorbent  system. 

The  larger  and  proper  trunk  of  the  lymphatic  system,  is 
generally  called  the  thoracic  duct,  because  it  was  first  oh  - 
Vol.  IV.  3 C 


202 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


served  by  Pecquet*  to  be  a vessel  which  conveyed  the  chyle 
through  the  diaphragm,  and  which  took  its  course  through  the 
whole  length  of  the  thorax,  to  throw  its  fluids  into  the  veins 
near  the  heart.  Before  his  time  the  lacteals  which  were  dis- 
covered by  Asellius,|  were  supposed  to  terminate  in  the  liver. 
The  first  discoverers  of  the  thoracic  duct,  described  it  as  be- 
ginning from  a pyriform  bag,  to  which  they  gave  the  name  of 
receptaculum  chyli.  In  dogs,  fish,  and  the  turtle,  such 
a cistern  or  bag  may  be  observed  ; but  in  the  human  body  no- 
thing further  is  to  be  observed  than  an  irregular  dilatation  of 
this  vessel,  like  a varicose  distention,  where  it  receives  the 
accession  of  the  lacteals  from  the  root  of  the  mesentery.  The 
origin  of  this  great  trunk,  called  the  thoracic  trunk,  is  the  uni- 
on of  the  vessels,  which  running  by  the  side  ot  the  common 
iliac  vessels,  are  derived  from  the  pelvis  and  lower  extremities. 
Upon  the  third  and  fourth  vertebra,  and  under  the  aorta  this 
trunk  is  frequently  joined  by  a large  trunk  of  the  lacteals,  and 
then  ascending,  it  receives  the  greater  number,  or  the  larger 
trunks  of  the  lacteals.  On  the  vertebrae  of  the  loins,  the  tho- 
racic duct  is  by  no  means  regular,  either  in  its  course  or  size 
or  shape  ; often  it  contracts,  and  again  irregularly  dilates,  as 
it  seems  to  emerge  from  under  the  aorta.  On  the  uppermost 
vertebra  of  the  loins,  the  thoracic  duct  lies  under  the  right 
crus  of  the  diaphragm,  and  then  passing  the  septum  with  the 
aorta,  it  gets  on  the  right  anterior  surface  of  the  spine,  and 
runs  up  betwixt  the  aorta  and  the  vena  azygos  ; it  then  passes 
under  the  arch  of  the  aorta,  and  there  it  is  considerably  en- 
larged, from  the  contracted  state  which  it  assumes  in  the  tho- 
rax. Sometimes  it  splits,  and  again  unites  on  the  vertebrse  of 
the  back.  Having  passed  the  arch  of  the  jiorta,  it  crosses  to 
the  left  side  of  the  spine,  and  wre  look  for  it  under  the  pleura 
on  the  left  side  of  the  oesophagus. 

The  thoracic  duct  now  emerges  from  the  thorax,  and  lies 
deep  in  the  lower  part  of  the  neck,  behind  the  lower  thyroid 
artery,  and  on  the  longus  colli  muscle. 

It  gets  above  the  level  of  the  subclavian  vein  of  the  left 
side,  and  here  it  receives  the  absorbents  of  the  head  and  neck 
(of  the  left  side,)  and  descends  again  with  a curve,  and  ter- 
minates in  the  angle  of  the  union  of  the  subclavian  vein  and 
jugular  vein  of  the  left  side. 

Sometimes  there  are  two  thoracic  ducts ; but  this  is  very  rare. 
Sometimes  the  duct  splits  near  its  termination,  and  the  twro 

* In  the  year  1651. 

f In  the  year  1622. — About  the  year  1652,  the  other  branches  of  the  fyf- 
tem,  which  take  their  courfe  to  every  part  of  the  body,  were  difcovered  by 
Rudbeck,  Jolyffe,  and  Thorn.  Bartholin. 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


203 


branches  enter  the  veins  separately  ; but,  in  general,  when  it 
splits  in  this  manner,  it  again  unites  before  it  terminates  in  the 
vein. 

There  is  constantlv  a trunk  in  the  anterior  mediastinum  un- 
der the  sternum,  as  large  as  the  thoracic  duct  itself,  which  is 
sometimes  inserted  into  the  termination  of  the  thoracic  duct ; 
sometimes  into  the  trunk  of  the  absorbents  of  the  left  side,  to  be 
immediately  described.* 

THE  TRUNK  OF  THE  ABSORBENTS  OF  THE  RIGHT  SIDE. 

The  absorbents,  from  the  right  side  of  the  head  and  neck, 
and  from  the  right  arm,  do  not  run  across  the  neck,  to  unite 
with  the  great  trunk  of  the  system  ; they  have  an  equal  oppor- 
tunity of  dropping  their  contents  into  the  angle  betwixt  the 
right  subclavian  and  jugular  vein.  These  vessels  then  unit- 
ing, form  a trunk  which  is  little  more  than  an  inch,  nay,  some- 
times not  a quarter  of  an  inch  in  length,  but  which  has  nearly 
as  great  a diameter  as  the  proper  trunk  of  the  left  side. 

This  vessel  lies  upon  the  right  subclavian  vein,  and  receives 
a very  considerable  number  of  lymphatic  vessels  : not  only 
does  it  receive  the  lymphatics,  from  the  right  side  of  the  head, 
thyroid  gland,  neck,  &c.  and  the  lymphatics  of  the  arm  ; but 
it  receives  also  those  from  the  right  side  of  the  thorax  and  dia- 
phragm, from  the  lungs  of  this  side,  and  from  the  parts  sup- 
plied by  the  mammary  artery.  Both  in  this  and  in  the  great 
trunk  there  are  many  valves. 

OF  THE  LACTEALS  AND  LYMPHATICS  OF  THE  INTESTINAL 

CANAL. 

We  have  already  remarked  the  great  length  of  the  intestinal 
canal,  the  effect  of  the  imperfect  valvular  structure,  in  extend- 
ing the  inner  coat  to  a great  length  : we  have  remarked  also, 
that  while  every  surface  of  the  body  secretes,  it  is  at  the  same 
time  an  absorbing  surface  ; and  finally,  that  while  we  chiefly 
contemplate  the  intestinal  canal,  as  imbibing  and  receiving 
the  nourishment,  we  must  not  forget  that  it  is  also  a secreting 
surface  of  the  first  importance  to  the  (Economy.  But  at  pre- 
sent we  have  merely  to  understand  that  structure  and  organi- 
zation, by  w'hich  this  canal  absorbs  the  nutritious  fluid,  the 
chyle,  from  the  food. 

In  the  first  place,  as  to  the  terms  lacteals  and  lymphatics,  we 
presume  that  the  absorbents  throughout  the  whole  length  of 


v Cruickthank*. 


204 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


the  canal  have  the  same  structure  and  use  ; and  that  the  terns 
lacteals  has  been  suggested  merely  by  the  colour  of  the  fluid, 
which  is  absorbed  from  the  small  intestines.  At  one  time  these 
lacteals  convey  a milky  fluid  : at  another  a transparent  fluid, 
like  that  which  the  stomach  and  great  intestines  in  general  ab- 
sorb. 

The  lacteals,  as  it  is  natural  to  suppose,  were  the  first  disco- 
vered of  any  part  of  the  system  of  absorbents  ; or,  at  least, 
they  were  first  understood  to  form  a part  of  an  absorbing  sys- 
tem. For  although  Eustachius,  a Roman  anatomist,  disco- 
vered the  thoracic  duct  in  the  year  1563,  yet  he  had  very  im- 
perfect notions  of  its  importance,  and  the  discovery  was  very 
little  attended  to,  till  after  the  discovery  of  the  lacteals  by  Asel- 
lius  in  1622.  This  anatomist,  in  opening  living  animals,  to  ob- 
serve the  motion  of  the  diaphragm,  observed  white  filaments 
on  the  mesentery,  which  he  took  at  first  for  nerves  ; but,  on 
puncturing  them,  and  observing  them  to  discharge  their  con- 
tents and  to  collapse,  he  proclaimed  his  discovery  of  a new  set 
of  vessels — a fourth  kind.* 

Had  Aseilius  only  chanced  to  observe  these  vessels,  his  me- 
rit would  have  been  inconsiderable  ; but  he  also  investigated 
and  announced  their  peculiar  offlce,  viz.  of  absorbing  the  chyle 
from  the  intestinal  canal,  and  carrying  it  into  the  blood. 

For  some  time,  however,  after  the  discovery  of  the  vasa 
lactea,  the  opinion  of  Hippocrates  and  Galen,  viz.  that  the 
mesenteric  veins  absorbed  the  chyle  from  the  intestines,  and 
conveyed  it  to  the  liver,  still  prevailed.  Even  after  the  disco- 
very of  the  lacteals  was  known  and  received,  a part  of  the  old 
system  was  still  retained,  and  it  was  supposed  that  those  vessels 
carried  the  fluids  absorbed  from  the  intestines  into  the  liver  ; 
and  that  the  fluids  were  there  converted  into  blood. 

About  twenty  years  after  the  discovery  of  Aseilius,  Rud- 
beck,  a Swede,  and  Bartholin,  a Danish  anatomist,  saw  Asel- 
lius’s  vessels  in  many  other  parts  of  the  body  ; discovered  the 
trunk  of  the  system,  and  showed  that  the  lacteals  did  not  pass 
to  the  liver,  but  that  they  were  branches  of  a great  and  distinct 
system  ; they  also  demonstrated  the  unity  of  this  system. 

We  have  seen  from  this  sketch  that  the  ancients  supposed 
the  veins  of  the  intestines  to  be  absorbents  ; and  even  after  the 
discovery  of  the  lacteals,  this  idea  has  been  retained  by  some 
of  the  best  modern  anatomists,  and  principally  by  Haller,  and 
professor  Mickel,  of  Berlin.  If  the  veins  absorb  from  the 
surface  of  the  intestines,  their  doctrine  would  imply  that  they 
are  also  absorbents  in  general  throughout  the  body.  Although 

* The  nerves  being  counted  as  vefiels, 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


20o 


Bartholin,  in  his  epistle  to  Harvey,  had  asserted  and  given  suf- 
ficient proof  that  the  mesenteric  veins  were  not  absorbents,  yet 
the  controversy  was  left  in  so  undecided  a state,  as  to  give  oc- 
casion to  the  series  of  experiments  in  the  school  of  the  Hun- 
ters, which  seems  to  have  put  the  question  to  rest,  in  as  far  as 
it  is  connected  with  the  lymphatic  s\  stem.* 

We  have  already  mentioned  that  Asellius  was  employed  in 
opening  the  belly  of  a living  dog,  when  he  fit  st  discovered  che 
lacteals.  He  perceived  upon  the  surface  of  the  intestines  and 
mesentery  a great  many  small  threads,  which  at  first  sight,  he 
took  for  nerves,  but  soon  discovered  his  error  ; and  to  dissipate 
his  doubt,  opened  one  of  the  largest  white  chords,  when  no 
sooner  had  the  incision  been  made,  than  he  saw  a fluid  like 
milk  or  cream  issue  from  the  vessels.  Asellius  says  he  could 
not  contain  his  joy  at  the  sight  of  this  phenomenon  ; and  turn- 
ing himself  to  Alexander  Tadinus,  and  the  senator  Septalius, 
who  were  present,  he  invited  them  to  enjoy  the  spectacle  ; but 
his  pleasure,  he  adds,  was  of  short  duration,  for  the  dog  died, 
and  the  vessels  disappeared.  The  natural  and  simple  narra- 
tion ol  Asellius  represents  his  astonishment,  and  gives  an  idea 
of  the  sensation,  which  the  anatomist  experiences  in  the  instant 
of  making  an  interesting  discoverv.f 

Origin  of  the  lactkals.  When  the  young  anatomical 
student  ties  the  mesenteric  vessels  of  an  animal  recently  killed, 
and  finds  the  lacteals  gradually  swell ; when  he  finds  them  tur- 
gid, if  the  animal  has  had  a full  meal,  and  if  he  has  allowed 
time  for  the  chyle  to  descend  into  the  small  intestines — and 
empty,  or  containing  only  a limpid  fluid  if  the  animal  has 
wanted  food  ; he  has  sufficient  proof  that  these  are  the  vessels 
destined  to  absorb  the  nutritious  fluids  from  the  intestines. 
Again,  when  coloured  fluids  are  thrown  into  the  intestines  of  a 
living  animal,  and  they  are  absorbed,  he  has  sufficient  proof  of 
their  free  and  ready  communication  with  the  inner  surface  of 
the  gut ; but  the  actual  demonstration  of  the  absorbing  mouths 
ol  the  lacteal  vessels  is  difficult  and  precarious.  The  difficul- 
ty arises  from  these  vessels  being  in  general  empty  in  the  dead 
body  ; from  the  impossibility  of  injecting  them  from  trunk  to 
branch  in  consequence  of  their  valves  ; and,  lastly,  from  their 
orifices  never  being  patent,  except  in  a state  of  excitement. 
The  anatomist  must  therefore  watch  his  opportunity  when  a 
man  has  been  suddenly  cut  off  in  health,  and  after  a full  meal. 
Then  the  villi  of  the  inner  coat  may  be  seen  turgid  with  chyle, 
and  their  structure  may  be  examined.  Perhaps  the  first  obser- 


See  the  veins  in  this  Volume, 
f Sheldon,  Portal. 


206 


OP  THE  COURSE  OF  THE  LYMPHATICS. 


vations  which  were  made  upon  this  subject  by  Lieberkuhn,  are 
still  the  best  and  the  most  accurate. 

The  villi  are  apparently  of  a cellular  structure,  for  although 
they  are  flat  or  conical,  or  like  filaments  when  collapsed  ; yet 
when  minutely  injected,  and  especially  when  they  are  full  of 
chyle,  they  take  a globular  form,  and  are  called  the  ampullu- 
Li£.  Their  distention,  in  consequence  of  a minute  injection  of 
the  veins  or  arteries,  is  probably  owing  to  a cellular  structure 
(which  they  seem  to  have)  into  which  the  injection  has  extra- 
vasated.  The  most  probable  account  of  the  structure  of  these 
ampullulse  is  that  this  cellular  structure  is  a provision  for  their 
inflation  and  erection  by  the  blood,  when  excited  by  the  pre- 
sence of  the  chyle  in  the  intestines  ; that  this  erection  gives 
rigidity  to  the  orifice  of  the  lacteals  ; and  that  the  first  step  of 
absorption  is  by  capillary  attraction,  while  the  further  propul- 
sion of  the  fluid  in  the  extreme  absorbents  is  by  the  contraction 
of  their  coats  excited  by  the  presence  of  the  fluid.  Thus  the 
absorption  is  not  by  an  inorganized  pore,  but  depending  on 
excitement  and  action. 

Liebei  kuhn’s  observations  of  the  villi  are  the  most  accurate 
and  curious.  He  observes,  that  having  opened  and  washed  a 
portion  oi  the  small  intestine,  its  whole  surface  will  be  found 
covered  with  little  pendulant  conical  membranes  of  the  fifth 
part  of  a line  in  size,  and  the  bases  of  which  almost  touch 
each  other.  From  the  vascular  membrane,  to  which  they  are 
attached,  he  observes  there  is  given  off  to  each  villus  a branch 
of  a lacteal,  an  artery,  a vein,  and  a nerve.  He  found  it  dif- 
ficult by  injection  to  show  both  the  vein  and  artery,  the  fluid 
passed  so  easily  from  the  one  into  the  other.  He  found  that 
the  extreme  branch  of  the  lacteal  was  distended  into  a little 
vessel  within  the  villus.  And  on  the  apex  of  which,  with  the 
microscope,  he  saw  one  or  sometimes  several  openings  ; with 
his  glasses  he  observed  the  arteries  to  ramify  on  the  globules  or 
ampullulse  and  again  collect  into  veins  ; and  he  supposed  that 
still  more  minute  branches  plunged  into  the  centre.  But  he 
made  a still  more  minute  observation  than  this.  Insulating  a 
piece  of  intestine  betwixt  two  rings,  only  leaving  a space  for 
the  entrance  of  the  ramification  of  the  artery  which  supplied  it, 
he  injected  with  a column,  and  examined  its  progress  at  the 
same  time  with  his  microscope.  As  he  raised  the  tube,  he  saw 
the  artery  going  in  serpentine  turns  to  the  villus,  and  the  injec- 
tion returning  by  the  veins  ; at  last  it  passed  into  the  ampulla 
lactea,  distended  it  and  made  its  exit  by  the  foramina.  He 
prepared  the  villi  in  another  way  : — he  inflated  the  ampullae, 
and  kept  them  so  until  they  dried ; then  he  cut  them  with  a 
razor,  and  found  them  cellular.  This  cellular  structure 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


20  7 


Cruickshanks  thinks  is  the  common  cellular  substance,  uniting 
the  vessels  of  the  villus.  When  this  gentleman  examined  the 
villi  of  a patient  who  died  suddenly  after  a meal,  he  observed 
some  of  them  to  be  turgid  with  chyle,  so  that  nothing  of  the 
ramifications  of  the  arteries  or  veins  were  to  be  observed  ; the 
whole  appeared  as  one  white  vessel  without  any  red  lines, 
pores,  or  orifices  ; others  of  the  villi  contained  chyle  in  a less 
proportion  ; and  here  the  ramifications  of  the  veins  were 
numerous,  and  prevailed  by  their  redness  over  the  whiteness  of 
the  villi. 

In  some  hundred  villi  he  saw  the  trunk  of  a lacteal  forming 
by  radiated  branches,  one  branch  in  each  villus.  Mr.  Cruick- 
shanks and  Dr.  Hunter  counted  fifteen  or  twenty  orifices  in 
some  of  the  villi. 

Mr.  Cruickshanks  has  remarked  a deep  and  a superficial  set 
of  lacteals  on  the  intestines  ; but  for  this  division  there  seems 
no  necessity.  Deep  in  the  coats  the  lacteals  seem  to  accompany7 
the  blood-vessels  ; but  when  they  get  more  superficial,  theyr 
take  a course  longitudinally  on  the  canal,  and  turn  deviously, 
or  after  running  a little  way,  take  a sudden  turn  towards  the 
mesentery. 

As  the  greater  frequency  of  the  valvulae  conniventes  in  the 
jejunum,  greatly  increase  the  extent  of  its  inner  surface  of  the 
gut,  and  consequently  give  a greater  extent  of  origin  to  the 
lacteals  ; and,  as  here  the  chyle  must  be  in  the  greater  quanti- 
ty, so  the  lacteals  of  this  portion  of  the  gut  are  larger  and 
more  numerous  than  in  any  other  part  of  the  extent  of  the 
can; 

x ie  lacteals  do  not  attach  themselves  to  the  vessels  of  the 
mesentery,  but  take  a course  individuallv,  or  forming  plexus. 
Before  they  enter  the  mesenteric  glands,  they  have  been  called 
lacteals  of  the  first  order ; when  they  emerge  from  the  first  into 
the  second  glands,  secondary  lacteals,  and  glands  of  the 
second  order.  The  manner  of  the  entering  and  going  out  of 
glands  is  exactly7  the  same  with  that  of  the  lvmphatics.  The 
lacteals  (or  perhaps  we  should  now  say  the  absorbents  merely7) 
of  the  great  intestines,  are  smaller  and  less  numerous  than 
those  of  the  small  intestines  ; for  although  the  intestines  be 
large,  still  their  inner  surface  is  by  no  means  so  extensive  ; 
besides  the  chyle  is  absorbed,  and  the  contents  altered  before 
they  have  descended  into  the  great  intestines.  Both  Winslow 
and  Haller,  however,  assert,  that  they  have  seen  chyle  in  the 
absorbents  of  the  great  intestines.  We  know  that  the  lacteals 
absorb  chyle,  when  it  is  presented  to  them  : while  at  other 
times  they  absorb  different  fluids.  That  the  absorbents  of  the 
great  intestines  imbibe  the  fluid  contents  is  evident,  from  the 


208  OF  THE  COURSE  OF  THE  LYMPHATICS. 

change  produced  on  the  faeces  in  their  passage.  Copious  and 
nutritious  injections  have  been  given,  which  did  not  return  in 
. the  same  liquid  form,  and  which  have  supported  the  strength 
for  some  time.  Clysters  of  turpentine  give  the  urine  a smell 
of  violets  ; and  the  Peruvian  bark  has  cured  fever,  when  giv- 
en by  the  rectum. 

The  absorbents  of  the  stomach  form  three  divisions  : one 
set  accompany  the  coronary  artery  and  vein,  and  enter  the 
glands  on  the  lesser  curvature  and  omentum  minus.  Those 
of  the  second  set  accompany  the  left  gastro-epiploic  artery,  and 
are  joined  by  the  lymphatics  of  the  omentum.  The  third  pass 
down  upon  the  upper  part  of  the  duodenum  following  the  ar- 
teria  gastrica  dextra  : these  descend  to  pass  into  the  same  class 
of  glands,  which  receive  the  lymphatics  of  the  liver.  They 
are  joined  in  their  course  by  the  lymphatics  of  the  right  side 
of  the  omentum. 

The  lacteals  on  the  mesentery  pass  from  one  gland  to  another 
till  they  form  one  or  two  large  trunks  only.  These  accompa- 
ny the  trunk  of  the  superior  mesenteric  artery,  and  run  down 
on  the  right  side  of  the  aorta,  and  join  the  thoracic  duct.  The 
absorbents,  from  the  rectum  and  colon  of  the  left  side,  pass  in- 
to their  glands,  or  sometimes  into  the  lumbar  glands,  and  join 
the  thoracic  duct  separately  ; those  from  the  right  side  of  the 
colon  join  or  mingle  with  the  lacteals  in  the  root  of  the  me- 
sentery. 

OF  THE  REMAINING  ABSORBENTS  OF  THE  SOLID  VISCERA. 

Where  the  lymphatics  of  the  lower  extremity  descend  over 
the  brim  of  the  pelvis,  they  are  joined  by  the  absorbents  of 
the  bladder,  vesicula;  seminales,  and  other  parts  in  the  pelvis  : 
small  glands  belonging  to  this  set  are  attached  to  the  internal 
iliac  vessels.  In  the  female,  the  lower  set  of  lymphatics, 
from  the  womb  and  vagina,  also  come  by  this  route  to  join 
those  of  the  lower  extremity,  or  run  mingling  with  them. 
Another  set  of  lymphatics  of  the  womb  pass  up  with  the  sper- 
matic vessels. 

The  lymphatics  of  the  testicle  are  very  numerous.  They 
come  in  distinct  sets  from  the  body  of  the  testicle,  from  the 
epididimis,  and  from  the  tunica  vaginalis  : then  reaching  the 
chord,  form  six  or  ten  trunks,  and  run  up  direct  to  the  abdo- 
minal ring  ; passing  the  ring,  they  turn  outward,  and  then 
pass  over  the  psoas  muscle  and  into  the  lumbar  glands. 

The  lymphatics  of  the  kidney  are  in  two  sets,  superficial 
and  deep  seated  ; but  the  former  are  seldom  to  be  observed. 
Sometimes  disease  makes  them  distinct.  The  internal  lym- 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


209 


jfnatics  are  demonstrated  by  blowing  into  the  veins,  or  tying 
a ligature  and  kneading  the  substance  of  the  kidney  with  the 
fingers  ; when  they  rise,  they  are  seen  attached  to  the  emulgent 
vessels,  and  go  to  join  the  lumbar  glands,  or  terminate  in 
large  lymphatics  near  the  aorta. 

It  is  needless  to  repeat  that  the  absorbents  of  the  spleen  are 
deep  and  superficial, — for  this  arrangement  is  general.  Emerg- 
ing from  the  spleen,  the  lymphatics  pass  along  the  splenic 
vessels,  and  enter  into  glands  attached  to  the  splenic  artery  in 
its  whole  course.  In  this  course  they  receive  the  absorbents 
from  the  pancreas,  and  near  the  head  of  the  pancreas,  they  are 
blended  with  those  of  the  liver,  and  with  them  join  the  thora- 
cic duct. 

The  lymphatics  of  the  liver  are  the  most  easily  detected, 
and  may  be  injected,  to  greater  minuteness,  than  in  any  other 
part  of  the  body.  Although  they  have  many  valves,  yet  they 
do  not  seem  to  close  the  vessels  entirely,  nor  interrupt  the  mer- 
cury from  passing  from  trunk  to  branch.  The  superficial 
lymphatics,  which  are  so  numerous  that  we  may  sometimes 
see  the  mercury  in  them  covering  completely  a considerable 
space,  have  free  communication  with  the  internal  set  of  vessels 
which  are  also  numerous  and  large.  The  principal  route  of 
the  lymphatics  of  the  upper  surface  of  the  liver,  is  by  the  broad 
ligament : these  perforating  the  diaphragm  join  the  trunk, 
which  we  have  noticed  under  the  sternum,  and  in  the  anterior 
mediastinum.  It  would  appear,  however,  that  these  lympha- 
tics of  the  broad  or  suspensory  ligament,  are  by  no  means  con- 
stant and  uniform  in  their  course  ; for  sometimes  they  run 
down  towards  the  lacteal  ligament,  and  perforate  it  there  ; some- 
times they  pass  down  into  the  thoracic  duct  while  still  in  the 
belly.  Other  lymphatics  of  great  size,  run  off  from  the  con- 
vex surface  of  the  liver  upon  the  lateral  ligaments,  and  pierce 
the  diaphragm.  The  lymphatics  on  the  lower  or  concave  sur- 
face of  the  liver  are  more  irregular  than  those  of  the  convex 
side.  They  unite  with  the  deep  lymphatics  coming  out  of  the 
porta  along  with  the  vena  portae,  enter  into  the  glands,  which 
are  seated  on  the  trunk  of  that  vessel,  and  join  the  thoracic 
duct  near  the  root  of  the  superior  mesenteric  artery. 

The  lymphatics  of  the  lungs  are  nearly  as  numerous  as 
those  of  the  liver  ; but,  indeed,  in  regard  to  this  expression,  it 
is  more  in  relation  to  the  facility  of  injecting  and  demonstrat- 
ing the  lymphatics,  than  to  their  comparative  number.  For  ex- 
ample, if  the  lymphatics  of  the  other  viscera  could  be  injected 
to  as  great  minuteness  as  those  of  the  liver,  we  should  cease 
to  consider  that  viscus  as  more  abundantly  supplied  than  other 
parts.  The  superficial  lvmphatics  of  the  lungs  form  areoite, 
VOL.  IV.  2 D 


210 


OF  THE  COURSE  OF  THE  LYMPHATICS. 


and  cover  the  surface  almost  completely.  They  take  a course 
to  the  root  of  the  lungs,  where  they  are  joined  by  the  deep  seat- 
ed vessels,  and  together  pass  into  the  bronchial  glands,  and 
here  the  lymphatics  of  both  sides  freely  communicate. 

The  glands  of  the  lungs  are  constantly  found  both  before 
and  behind  the  bifurcation  of  the  trachea  : often  these  glands 
are  of  a very  dark  colour  ; nay,  their  substance  is  sometimes 
found  resolved  as  it  were  into  a sac  of  inky-like  fluid.  Upon 
the  arch  of  the  aorta,  and  the  root  of  its  great  branches,  are 
the  cardiac  glands,  which  receive  the  lymphatics  from  the 
heart.  The  absorbents  of  the  heart  are  small,  but  very  nu- 
merous, and  their  larger  branches  attach  themselves  to  the 
coronary  vessels.  They  then  pass  to  the  cardiac  glands,  and 
mingling  with  those  from  the  lungs,  join  the  thoracic  duct. 


APPENDIX ; 


CONTAINING  THE 


DESCRIPTION  OF  THE  VENOUS  SYSTEM  AND 
THE  ANATOMY  OF  THE  TEETH. 


CHAP.  I. 


OF  THE  VEINS  IN  GENERAL. 


I HE  veins  are  those  vessels  by  which  the  blood  carried  out- 
ward by  the  arteries,  is  returned  to  the  heart.  The  system  of 
the  veins  however  is  not  so  simple  as  that  of  the  arteries,  for 
while  there  are  only  two  great  arteries  carrying  the  blood  from 
the  heart,  viz.  the  aorta  and  the  pulmonic  artery,  there  are 
three  great  trunks  of  the  veins,  viz.  the  superior  and  inferior 
vena  cava,  the  trunks  of  the  great  veins  of  the  body  ; the  pul- 
monic vein,  which  returns  the  blood  to  the  heart  from  the  cir- 
culation through  the  lungs  ; and  the  vena  portae,  which  col- 
lects the  blood  of  the  intestines,  and  conveys  it  to  the  liver. 
There  are  besides,  a greater  variety  in  the  distribution,  of  the 
veins,  than  in  that  of  the  arteries. 

The  French  physiologists  have  departed  from  the  old  method 
of  Harvey,  in  explaining  the  circulation.  He  wisely  took  the 
heart  as  the  centre  of  the  system,  and  described  the  vessels 
going  out  from  it,  forming  the  two  circulations,  viz.  through 
• the  body  and  through  the  lungs  ; but  they  have  assumed  the 
lungs  as  the  centre  ; and  the  veins  of  the  body,  and  the  arte- 
ries of  the  lungs,  they  call  systeme  a sang  noir,  because  it  con- 
tains the  dark  coloured  blood  ; and  the  pulmonic  veins  and  the 
arterial  system  of  the  body,  they  call  systeme  a sang  rouge , 
because  it  conveys  blood  of  the  bright  vermilion  colour. 

This  conceit  is  perhaps  admissible,  when  introduced  as  an 


212 


APPENDIX. 


illustration  of  the  relation  of  the  lungs  to  the  body  ; but  in  the 
general  announcing  of  the  system,  and  considered  as  a basis 
oi  demonstration,  it  gives  to  a difficult  subject  an  unusual  de- 
gree of  intricacy  in  the  mind  of  the  young  student  : besides, 
the  arteries  and  veins  of  the  body,  and  the  pulmonic  artery 
and  vein,  have  that  strict  and  mutual  dependence  in  action, 
•which  shows  how  improper  and  how  unnatural  it  is  to  make 
this  change,  and  to  separate  them  in  explaining  the  general 
system.  At  all  events,  let  those  who  adopt  this  novelty  cease 
to  speak  of  the  two  circulations,  for  although  in  regard  to  the 
heart,  there  are  two  circulations,  yet  as  the  movement  of  the 
blood  respects  the  lungs,  there  is  only  one.  By  this  division, 
the  blood  returning  from  the  body  and  carried  into  the  lungs, 
cannot  be  called  a circulation  ; but  only  when  it  has  passed 
through  the  lungs,  and  returned  to  the  same  point  of  its  course 
through  the  body. 

GENERAL  CHARACTER  OF  THE  VEINS. The  Capacity  of 

the  veins,  is  larger  than  that  of  the  arteries  ; the  coats  thinner 
but  stronger  comparatively,  and  admitting  of  much  dilatation. 
The  coats  cf  the  lesser  veins,  are  comparatively  stronger  than 
those  of  the  larger  ones,  and  the  veins  of  the  lower  extremity 
much  thicker  and  stronger,  than  in  the  upper  parts  of  the  body, 
as  they  bear  a higher  column  of  blood.  The  veins  are 
transparent  and  the  blood  is  seen  through  their  coats.  There 
can  be  properly  distinguished,  only  two  coats  in  the  veins  ; 
the  outer  coat,  which  is  flocculent  and  cellular  without,  to  con- 
nect with  the  surrounding  parts,  smoother  and  more  compact 
•within,  where  it  is  united  with  the  inner  coat.  In  it  are  rami- 
fied the  vasa  vasorum  ; and  a fibrous  structure  is  to  be  observed 
in  some  of  the  larger  and  superficial  trunks  ; the  striae  or  fibres 
running  longitudinally.  The  inner  coat  is  firm  and  compact 
and  intimately  united  to  the  other  ; it  is  smooth,  flexible,  and 
formed  into  valves  in  various  parts. 

In  all  the  larger  veins,  excepting  those  of  the  viscera  of  the 
abdomen,  and  those  of  the  lungs  and  brain,  there  are  valves  : 
these  valves  consist  of  the  inner  coat,  forming  folds  like  a 
semilunar  curtain,  hung  across  the  caliber  of  the  vein  ; but  at 
the  same  time  attached  so  obliquely  to  the  side  of  the  vein, 
that  they  present,  a sacculated  membrane  to  receive  the  refluent 
blood.  The  loose  margin  of  the  valve  is  somewhat  stronger 
than  the  other  part,  and  betwixt  the  duplicature  some  splendid 
little  filaments  are  sometimes  observed.  Each  valve  consists 
in  general,  of  two  semilunar  membranes,  the  margins  of 
which,  falling  together,  prevent  the  blood  from  passing  retro- 
grade ; but  they  yield  and  collapse  to  the  side  of  the  vein  by 
the  current  of  blood  flowing  towards  the  heart.  As  the  veins 


APPENDIX* 


213 


are  provided  with  valves  only  where  they  are  exposed  to  occa- 
sional pressure,  and  particularly  to  the  compression  of  the 
muscles  ; their  chief  use  would  seem  to  be,  to  prevent  the  re- 
trograde movement  of  the  blood,  from  the  occasional  compres- 
sion of  the  veins  ; but  no  doubt,  they  at  the  same  time  support 
the  column  of  blood,  as  in  the  lower  extremities  : and  when 
those  veins  suffer  distention  by  disease,  a great  aggravation  is, 
that  the  valves  lose  their  action,  become  too  small  to  close  the 
dilated  vein,  and  the  whole  column  of  blood  presses  upon  the 
veins  of  the  legs. 

The  commencement  of  the  minute  branches  of  the  veins,  is 
from  the  extreme  ramifications  of  the  arteries  ; they  are  con- 
tinuous, and  perpetuate  the  motion  of  the  blood  in  that  course 
which  is  called  the  circulation.  In  contemplating  the  capillary 
tissue  of  vessels,  the  most  striking  circumstance  is,  the  pre- 
dominance of  the  dark  venous  ramifications  : and  in  general, 
two  sets  of  veins  will  even  in  these  minute  ramifications,  be  ob- 
served ; one  superficial,  the  other  more  intimately  blended 
with  these  minute  ramifications  of  the  arteries  ; but  in  the  in- 
ternal parts  of  the  body,  and  particularly  the  viscera,  the  veins 
uniformly  accompany  the  ramifications  of  the  arteries,  and  in 
the  solid  viscera,  a dense  cellular  membrane  gives  promiscuous 
lodgement  to  both  sets  of  vessels. 

In  the  extremities  and  head,  indeed  every  where  but  in  the 
viscera,  the  veins  form  two  distinct  sets  ; the  deep  and  the 
superficial  veins  : the  deep  veins  accompanying  the  arteries  ; 
and  the  subcutaneous  veins,  which  emerge  from  the  compres- 
sion ol  the  muscles,  and  run  above  the  fascia.  The  union  be- 
twixt the  branches  of  the  veins,  is  very  frequent,  not  only  be- 
twixt the  veins,  ramifying  in  the  same  plane  in  so  much  as  to 
make  them  a mere  network  ; but  also  betwixt  the  deep  and  the 
superficial  set  of  veins  : such  are  the  venae  emissarise  of  the 
scull  ; the  free  communications  betwixt  the  external  and  inter- 
nal jugular  vein,  betwixt  the  deep  and  superficial  veins  of  the 
arm,  &c.  When  in  bleeding,  the  blood  flows  from  the  vein  of 
the  arm,  accelerated  by  the  working  of  the  muscles,  the  blood 
escapes  by  the  anastomosis,  from  the  compression  of  the 
muscles,  and  fills  the  superficial  veins  ; but  the  increase  of  the 
jet  of  blood,  is  more  the  effect  of  the  swelling  of  the  muscles, 
causing  the  fascia  to  compress  the  veins  of  the  fore-arm. 

In  the  dead  body  the  veins  are  flat,  but  when  distended,  they 
resume  the  cylindrical  figure  which  they  possessed  in  the  living 
body : yet  they  are  in  general  of  the  cylindrical  figure,  for  a 
very  little  way  only,  owing  to  the  irregular  dilatations  by  the 
side  of  the  valves,  or  by  the  frequent  union  of  their  branches. 
The  manner  in  which  the  branches  join  the  trunk,  has  a peculi- 


214 


APPENDIX. 


arity  which  always  distinguishes  it  from  the  ramifications  of 
arteries  ; the  arteries  branch  off  at  a direct  and  acute  angle,  the 
veins  in  a direction  more  removed  from  the  course  of  the  trunk, 
and  in  general  with  a curve  or  shoulder. 

In  infancy  and  youth,  the  veins  are  little  turgid,  and  especi- 
ally the  cutaneous  veins,  are  so  firmly  embraced  by  the  elastic 
skin  and  cellular  membrane,  that  they  have  a less  degree  of  pro- 
minency than  in  more  advanced  years.  In  old  age,  the  veins 
are  enlarged,  and  rise  turgid  on  the  surface,  and  the  internal 
veins  also  become  enlarged  and  varicose.  I do  not  consider 
this  change  in  the  vascular  system,  as  the  effect  of  mere  disten- 
tion, or  of  the  enlargement  of  the  veins  from  the  long-conti- 
nued action  of  the  arteries  ; but  as  a necessary  change  in  the 
proportionate  distribution  of  the  blood,  which  is  preceded  or 
accompanied  with  other  peculiarities,  the  character  of  old  age. 
When  we  consider  the  great  proportion  of  the  veins  in  size, 
over  the  arteries,  we  must  conclude  that  the  blood  flows  but 
slowly  in  the  venous  system  : that  from  the  narrowness  of  the 
trunks  of  the  veins  near  the  heart,  the  blood  must  be  accelera- 
ted, as  it  approaches  the  heart,  and  that  receiving  the  impulse 
from  the  ventricle,  it  must  take  a rapid  course  through  the  ar- 
teries, until  again  approaching  the  extreme  branches  of  the  ar- 
teries and  passing  into  the  veins,  its  motion  becomes  more  lan- 
guid and  slow.  In  youth,  as  the  size  of  the  veins  is  not  in  so 
great  a proportion  to  the  arteries,  as  in  advanced  life,  the  blood 
in  a young  person,  must  be  in  more  rapid  and  quick  circula- 
tion ; but  in  old  age,  in  proportion  to  the  largeness  of  the  veins 
and  the  accumulation  of  blood  in  them,  the  quantity  of  blood 
moving  slowly  through  the  venous  system,  and  almost  stagnant 
in  the  dilated  veins  and  sinuses,  is  very  great ; it  moves  but 
slowly  and  progressively  on  towards  the  centre  of  the  circula- 
tion ; and  upon  the  whole,  the  blood  in  old  people,  moves  less 
briskly  through  the  vessels,  and  the  proportionate  quantity  im- 
mediately under  the  influence  of  the  arterial  system,  is  less 
than  in  youth. 

There  is  no  pulsation  to  be  observed  in  the  veins,  but  what 
they  receive  laterally  from  the  contiguous  arteries.  There  is 
no  pulsation  in  the  veins,  because  they  are  removed  from  the 
heart  ; because  they  do  not  receive  the  shock  of  the  heart’s  ac- 
tion in  their  trunk,  but  only  by  their  widely  spread  branches  ; 
because  the  contraction  of  the  heart,  and  of  the  arteries  so  al- 
ternate with  each  other,  in  such  a manner  as  to  keep  up  a per- 
petual and  uniform  stream  of  blood  into  the  veins  ; whereas 
the  pulsation  in  the  arteries  is  owing  to  the  sudden  and  inter- 
rupted contraction  of  the  heart. 

In  this  general  account  of  the  venous  system,  it  remains  only 


APPENDIX. 


215 


to  speak  of  the  subject  of  absorption.  Before  the  suit  of  expe- 
riments made  on  this  subject  by  Mr.  Hunter,  a vague  notion 
was  entertained  that  the  veins  were  absorbents  ; but  about  that 
time,*  the  doctrine  that  lymphatics  are  absorbents  having  been 
established,  the  opinion  that  the  red  veins  were  also  absorbents, 
was  first  questioned,  and  finally  confuted,  at  least  in  the  opinion 
of  most  physiologists. 

The  chief  argument  to  show  that  veins,  arising  from  cavi- 
ties, particularly  from  the  intestines,  acted  as  absorbents,  was, 
that  some  anatomists  said  they  had  seen  white  chyle  in  the 
blood  taken  from  the  mesenteric  veins.  It  was  however  soon 
observed  that  the  serum  of  the  blood,  taken  from  the  veins  of 
the  arm,  was  sometimes  white,  which  must  arise  from  some 
other  cause  than  the  absorption  of  chyle. f 

The  experiments  of  Mr.  John  Hunter,  proved  that  there  is 
no  absorption  of  fluid,  from  aliment  contained  in  the  intestinal 
canal,  by  the  veins  of  the  mesentery,  while  the  lacteals  were 
Papidly  absorbing.  Emptying  a portion  of  the  gut,  and  the 
veins  of  their  blood  in  a living  animal,  he  poured  milk  into  the 
intestine.  The  veins  remained  empty,  and  without  a drop  of 
the  milk  finding  its  way  into  them,  while  the  lacteals  became 
tinged  with  it.  In  another  experiment,  leaving  the  arteries 
and  veins  of  the  mesentery  free  and  the  circulation  through 
them  perfect  ; still  no  white  fluid  could  be  discovered,  tinging 
the  stream  of  blood  in  the  veins.  Neither  did  pressure  upon 
the  gut,  in  any  instance  force  the  fluid  of  the  intestines  into  the 
veins. — He  repeated  and  varied  these  experiments,  so  as  to 
show  in  a very  satisfactory  manner,  that  chyle,  or  the  fluid  of 
the  intestines,  never  is  absorbed  by  the  veins. 

Yet  I must  say  that  these  experiments  are  still  unsatisfacto- 
ry, as  they  regard  the  general  doctrine  of  absorption  by  the 
veins  : in  the  intestines  there  is  a peculiar  set  of  vessels  evi- 
dently destined  to  the  absorption  of  the  chyle  and  of  the  fluids 
of  the  cavity  ; but  there  remains  a question  which  will  not  be 
easily  determined  : do  not  the  veins  throughout  the  body  re- 
sume a part  of  that  substance,  or  of  those  qualities,  which  are 
deposited  or  bestowed  by  the  arteries  ? — We  are  assured  that 
in  the  circulation  of  the  blood  through  the  lungs,  and  in  the  ex- 
tremities of  the  pulmonic  veins,  there  is  an  imbibing  or  absorp- 
tion : and  in  the  veins  of  the  placenta,  there  is  not  only  an  ab- 
sorption similar  to  what  takes  place  in  the  extreme  branches  of 
the  pulmonic  circulation,  but  the  matter  and  substance  which 
goes  to  the  nourishment  of  the  foetus,  is  imbibed  from  the  ma- 

* 1 758. 

f See-Hewfon’s  Exper.  Efiays  and  Lymphatic  Syftem. 


216 


APPENDIX. 


ternal  circulation.*  So  by  the  vessels  in  the  membrane  of  the 
chick  in  ovo,  there  is  absorbed  that  which  being  carried  to  the 
chick,  bestows  nourishment  and  increase.  For  my  own  part, 
I cannot  but  suppose  that,  while  the  lymphatics  absorb  the 
loose  fluids  which  have  been  thrown  out  on  surfaces,  or  into 
cavities — the  veins  receive  part  of  what  is  deposited  from  the 
arteries  ; but,  which  is  not  so  perfectly  separated  from  the  in- 
fluence of  the  circulating  system,  as  that  which  the  lymphatics 
receive  ; and  that  there  are  certain  less  palpable,  and  perhaps 
gaseous  fluids,  which  they  imbibe  in  the  course  of  the  circula- 
tion by  an  affinity  of  the  venous  blood,  similar  to  the  attraction 
which  takes  place  in  the  lungs.  We  must  at  the  same  time  ac- 
knowledge, that  the  conclusions  made  in  favour  of  absorption 
by  veins,  from  experiments  upon  the  dead  body/are  fallacious, 
and  have  no  weight. — It  is  seldom  we  can  determine  whether 
minute  injections  have  taken  a course  by  a natural,  or  by  a 
forced  passage  : neither  are  the  experiments  of  some  of  the 
older  physiologists  more  satisfactory  or  conclusive.  Lower 
affirmed  that,  by  throwing  a ligature  on  the  inferior  cava  of  a 
dog,  he  produced  ascites.  He  tied  the  jugular  veins  of  a dog, 
and  the  head  became  dropsical.  Hewson  repeated  these  expe- 
riments, but  without  the  same  result.  And  if  the  tying  of  the 
veins  had  always  produced  oedema  or  dropsy,  the  experiment 
would  have  proved  nothing  more  than  is  already  established  by 
the  very  common  occurrence  of  oedema  of  the  legs,  from  the 
pressure  of  the  womb  on  the  iliac  veins,  or  a tumor  in  the  groin, 
or  in  the  pelvis.  Now  in  these  instances  the  compression  of 
the  vein  does  nothing  more  than  cause  a difficult  circulation  of 
the  blood,  from  the  extreme  arteries  into  the  veins,  and  con- 
sequently a greater  profusion  of  the  discharge  into  the  cellu- 
lar texture  by  the  serous  arteries. 

OF  THE  VEINS,  BRANCHES  OF  THE  SUPERIOR  VENA  CAVA. 

The  superior  vena  cava,  or  the  descending  cava,  is  the  su- 
perior trunk  of  the  venous  system  ; which  receives  the  veins 
of  the  head,  neck,  and  arms,  and  throws  the  blood  directly  into 
the  great  right  sinus,  or  auricle  of  the  heart. 

* Dr.  Hunter,  Hewfon,  &c.fay  that  it  is  probable  there  are  many  fmall  lym- 
phatics in  the  placenta,  which  open  into  fhe  branches  of  the  veins,  and  do  not 
take  a courfe  along  the  chord.  This  is  very  improbable,  and  has  no  fupport  from 
analogy. 


APPENDIX. 


217 


SECTION  I. 

OP  THE  VEINS  OF  THE  HEAD  AND  NECK. 

The  anterior  facial  vein.'*  The  facial,  or  anterior 
facial  vein,  runs  down  obliquely  from  the  inner  canthus  of  the 
eye,  towards  the  angle  of  the  lower  jaw-bone.  Here  uniting 
with  the  temporal  vein,  it  forms  the  external  jugular  vein. 
The  most  remarkable  branches  of  veins  which  assist  in  form- 
ing the  facial  vein,  are  the  frontal  veins  ; which  receive 
the  blood  from  the  forehead  and  frontal  portion  of  the  occipito- 
frontalis muscle,  and  the  ophthalmic  vein,  which  is  one  of 
the  emissariae,  and  comes  from  the  cavernous  sinus  through 
the  orbit. — In  its  course  down  the  cheek,  the  facial  vein  re- 
ceives the  several  cutaneous  branches  of  veins,  from  the  sur- 
rounding parts  : but  which  have  in  reality  no  such  importance 
as  to  require  description.! 

The  posterior  facial  vein  ; or,  great  temporal 
vein. — This  vein  descends  from  the  temple  before  the  ear, 
through,  or  under  the  mass  of  the  parotid  gland,  and  behind 
the  angle  of  the  lower  jaw. 

This  posterior  vein  receives  those  branches  which  are  the 
proper  temporal  veins,  and  which  are  four  in  number,  and 
descend  upon  the  side  of  the  head  and  those  which  answer 
to  the  submaxillary  artery,  and  also  the  vena  transversa  faciei, 
and  the  auricular  veins.  Finally  into  some  of  the  deep  branch- 
es of  this  vein  § the  blood  enters  from  the  veins  accompanying 
the  arteria  meningea.  The  posterior  facial  vein,  uniting  with 
the  anterior  one,  forms  a common  trunk,  which  in  general  lies 
over  the  division  of  the  carotid  artery. 

EXTERNAL  JUGULAR  VEINS. 

The  external  jugular  vein  takes  a course  obliquely  down 
the  neck,  and  across  the  middle  of  the  mastoid  muscle.  It 
lies  under  the  fibres  of  the  plat\sma  myoides  muscle,  and 
drops  either  into  the  subclavian  vein,  or  into  the  internal  jugu- 
lar vein.  Sometimes  there  are  two  external  jugular  veins  on 
each  side  ; more  commonly  there  are  two  branches  high  in  the 
neck,  from  the  anterior  and  posterior  facial  veins,  which  unite 

9 Facial  •vein  ; V,  Angular  is  j V.  'Triangularis . • 

*f*  Vena  dotfalis  nafyfuperior  et  inferior— -Vena  palp cbralis  inferior  externa  et  inter • 
na—V ma  alaris  naji— Veres  labia  et  m agree  et  minores 3 &C.  Verne  buccales3  &C. 

t Being  in  two  fets,  the  deep,  and  fuperficial. 

§ Viz.  Vsnce  Fterygoidece. 

Vol.  IV.  2 E 


APPENDIX. 


218 

about  the  middle  of  it.  When  they  are  double  they  have  this 
course  ; the  anterior  and  external  jugular  vein,  may  be  said  to 
begin  from  the  anterior  facial  vein  ; it  then  receives  the  sub- 
mental  vein,  which  comes  in  under  the  base  of  the  lower  jaw— 
the  ranine  veins  also,  and  veins  from  the  glands  under  the  jaw 
join  it  here  : where  it  is  before  the  mastoid  muscle,  it  forms 
free  communications  writh  the  internal  jugular  veins  ; and  here 
also,  it  receives  veins  from  the  side  of  the  throat.* 

Almost  all  the  ramifications  of  veins,  which  in  one  subject 
unite  to  the  external  jugular  vein,  and  which  come  from  che 
face  and  throat,  do  in  others  sink  down  into  the  internal  jugu- 
lar vein. 

Sometimes  the  anterior  and  external  jugular  veins  join  the 
internal  jugular  vein  ; sometimes  the  subclavian  vein. 

The  posterior  external  jugular  vein  is  form,  d chieflv  by  the 
temporal  vein,  or,  posterior  facial  vein,  which  comes  down 
from  under  the  parotid  gland  ; it  is  then  joined  by  the  occipi- 
tal veins,f  a little  lower  by  the  cervical  veins,  and  lastly  on  the 
lower  part  of  the  neck  it  receives  the  muscular  branches  from 
the  flesh  of  the  shoulder  ; it  then  sinks  into  the  subclavian 
veins. 

Of  the  thyroid  veins. — The  thyroid  gland  has  two  sets 
of  veins,  as  it  has  of  arteries  ; the  superior  thyroid  veins  car- 
ry back  the  blood  from  the  muscles  of  the  fore  part  of  the 
throat,  from  the  larynx,  from  the  substance  of  the  thvroid 
gland,  and  from  the  neighbouring  part  of  the  trachea  and  pha- 
rynx, and  even  from  the  fauces.  Sometimes  these  thyroid 
veins  enter  the  external  jugular  vein  ; sometimes  they  descend 
upon  the  neck,  taking  the  name  of  guttural  veins  ; they 
unite  themselves  with  the  internal  jugular  vein. 

The  lower  thyroid  veins. — Come  from  the  lower  part 
of  the  thyroid  gland,  and  descend  upon  the  fore  part  of  the  tra- 
chea, and  enter  the  subclavian  ; or,  more  generally,  the  great, 
or  internal  jugular  veins. 

Of  the  internal  jugular  vein — The  internal  jugular 
vein  is  formed  by  the  conflux  of  the  several  great  and  posterior 
sinuses  of  the  dura  mater  into  the  lateral  sinus,  which  coming 
out  by  the  foramen  lacerum  posterius  of  the  basis  cranii,  ceases 
to  be  constricted  into  the  triangular  shape,  and  takes  the  form 
and  peculiarities  of  a vein.  From  this  foramen,  common  to 
the  temporal  and  occipital  bone,  the  jugular  vein  descends  ob- 
liquely forward  and  downward,  becoming  from  its  deep  situa- 

* Viz.  The  fuperior  thyroid  veins,  and  the  deep  laryngeal  veins. 

f Thefe  communicate  with  the  vertebral  veins,  and  through  the  pofterior 
znaftoid  foramen  with  the  lateral  finus; 


APPENDIX. 


219 


tion  somewhat  more  superficial,  but  in  all  its  extent  protected 
by  the  sterno-cleido-mastoideus  muscle  ; and  it  passes  under 
the  omo-hyoideus  muscle.  The  internal  jugular  vein  is  very 
irregular  in  its  form  ; being  sometimes  much  contracted  under 
the  angle  of  the  jaw  ; bulging  and  much  enlarged,  or  rather 
capable  of  being  much  distended  in  the  middle  of  the  nerk  ; 
and  again  contracted  before  it  joins  the  subclavians.  The 
carotid  artery,  the  internal  jugular  vein,  and  the  par  vagum 
lie  together  in  the  same  sheath  ot  loose  cellular  membrane. 

The  internal  jugular  vein  receives  these  communications 
and  branches  ; behind  the  angle  of  the  lower  jaw,  a branch  of 
communication,  generally  goes  down  from  the  posterior  facial 
vein,  and  often  it  is  joined  by  the  internal  maxillary  vein  : un- 
der the  jaw,  it  either  forms  free  communications  with  the  be- 
ginning of  the  external  jugular  vein,  or  it  receives  the  ranine 
and  guttural  veins;  at  all  events,  there  is  a branch  from  the  side 
of  the  throat,  and  the  muscles  ot  the  os  hyoides  which  passes 
into  the  internal  jugular  vein.  From  under  the  back  part  of 
the  mastoideus  muscle,  it  receives  branches  from  the  occipital 
veins,  and  forms  communications  with  the  vertebral  veins  : 
near  its  termination  the  great  jugular  vein  receives  the  guttural 
and  lower  thyroid  veins. 

Of  the  vertebral  vfins. — There  is  difficulty  in  assign- 
ing origins  to  these  veins,  for  they  are  rather  like  a chain  of 
communication  ; they  run  in  the  holes  of  the  transverse 
apophysis  of  the  cervical  vertebrae,  and  surround  the  processes 
with  areolae.  First  a communication  is  formed  with  the  great 
lateral  sinus,  then  they  receive  the  flat  sinuses  from  under  the 
dura  mater,  covering  the  cuneiform  process  of  the  occipital 
bone,  (the  basilar  sinuses)  and  as  they  descend  they  form 
transverse  communications,  which  receive  the  branches  of  that 
chain  of  inosculations,  which  runs  down  upon  the  spinal  mar- 
row. The  vertebral  veins,  in  their  descent,  send  out  divisions 
which  run  down  upon  the  outside  of  the  canal,  and  receive 
branches  of  veins  from  the  muscles  on  the  fore  part  of  the 
vertebra,  and  some  of  the  proper  cervical  veins  from  behind. 
The  vena  cervicalis  coming  from  the  side  of  the  neck,  unites 
with  the  vertebral  vein  near  its  termination,  in  the  back  part 
of  the  subclavian,  or  sometimes  in  the  axillary  vein. 


220 


appendix. 


SECTION  II. 

OF  THE  VEINS  OF  THE  ARM. 

The  veins  of  the  arm  are  in  two  sets,  the  vense  comites  5 
and  the  external  or  subcutaneous  veins,  being  those  without 
the  fascia,  and  not  subject  to  the  compression  of  the  muscles. 
Of  these,  the  latter  are  the  more  important  and  require  a par- 
ticular description. 

On  the  palm  of  the  hand,  the  veins  are  few  and  small,  be- 
cause they  are  there  subject  to  compression  in  the  frequent 
grasping  of  the  hand;  but  on  the  back  of  the  hands  and  fin- 
gers, the  veins  are  numerous  and  large.  The  veins  creeping 
along  the  fingers,  make  a remarkable  inosculation  on  the  back 
of  the  first  phalanges,  and  then  passing  in  the  interstices  of  the 
knuckles,  form  a great  and  irregular  plexus  on  the  back  of  the 
hand  the  principal  branch  of  which  sometimes  takes  the 
form  of  an  arch.f 

The  plexus  of  veins  from  the  back  of  the  hand  is  continued 
over  the  back  of  the  wrist  : when  some  of  the  larger  branches, 
after  playing  over  the  heads  of  the  radius  and  ulna,  take  a 
course,  the  one  on  the  lower,  and  the  other  over  the  upper  edge 
of  the  arm,  whilst  the  back  of  the  arm  is  left  without  any  re- 
markable veins  taking  their  course  there. 

The  veins  on  the  back  of  the  hand  have  nerves  interming- 
ling with  them,  viz.  branches  of  the  ulnar  nerve,  and  the  ex- 
treme branches  of  the  muscular  spiral  nerve  : so  that  it  is  a 
great  mistake  to  suppose  that  bleeding  in  the  back  of  the  hand 
might  be  substituted  with  advantage  for  the  common  operation 
in  the  bend  of  the  arm. 

Vena  cephalic  a. — The  vein  of  the  back  of  the  thumb 
running  into  a trunk,  which  takes  a course  over  the  outside  of 
the  wrist,  is  called  cephalic  a pollicis. 

From  this  vein  and  the  division  of  the  plexus  of  the  back  of 
the  hand,  a considerable  trunk  is  generally  formed,  which 
takes  its  course  on  the  radial  edge  of  the  arm,  and  is  called 
cephalica  minor,  or  radjalis  externa.  This  vein  in  its 
tract  over  the  extensor  radialis,  and  the  supinator  longus,  has 
many  lateral  communications,  particularly  with  the  median 
vein. 

This  vein,  now  joined  by  the  median  cephalic,  and  rising 
upon  the  outside  of  the  humerus,  is  the  great  cephalic  vein  ; 
and  it  passes,  first  betwixt  the  biceps  and  triceps  brachii,  and 

* Plexus  dorfalis  manus . Arcus  ‘venojus  dor/alis* 


APPENDIX. 


221 


then  betwixt  the  deltoides  and  pectoralis  major  muscles.  Se- 
veral small  cutaneous  veins  play  over  the  belly  of  the  biceps 
muscle,  and  communicate  with  the  basilic  vein  ; a little  below 
the  external  condyle  ot  the  os  humeri,  the  cephalic  vein  de- 
taches a branch  which  ascends  betwixt  the  brachialis  internus 
and  supinator  longus,  and  which  afterwards  forms  inoscula- 
tions with  the  basilic  vein,  on  the  back  of  the  arm. 

The  great  cephalic  vein  passing  up  betwixt  the  tendons  of 
the  pectoralis  major  and  the  deltoid  muscles,  sinks  into  the 
axilla  and  joins  the  axillary  vein.  The  lesser  cephalic  is  a 
vein  which  runs  up  betwixt  the  pectoral  and  deltoid  muscles, 
and  sinks  generally  into  the  subclavian  vein  : sometimes  it 
joins  the  external  jugular  vein. 

Vena  basilica.*  We  trace  the  origin  of  the  basilic  vein 
from  those  veins  which,  being  continued  from  the  plexus,  on 
the  back  of  the  hand,  take  their  course  over  the  lower  head  of 
the  ulna.  (A  conspicuous  branch  of  these  veins,  from  the 
little  finger,  was  called  salvatella  by  the  ancients.)  From  this 
origin,  the  basilic  vein  takes  a spiral  course  on  the  ulnar  edge 
of  the  fore-arm,  sometimes  in  one  great  trunk,  oftener  in  two, 
sometimes  in  a plexus  of  veins  ; here  it  may  be  called  ulnaris 
supfrficialis,  or  cubitalis  interna.  This  vein,  now 
rising  before  the  inner  condyle  of  the  humerus,  passes  on  the 
inner  margin  of  the  biceps  flexor  muscle  ; here  it  forms  very 
free  and  numerous  connections  with  the  internal  or  brachial 
vein  ; the  satellites  and  cephalica,  now  passing  up,  until  it  sinks 
under  the  tendon  of  the  pectoral  muscle,  it  joins  the  axillary 
vein. 

The  great  basilic  vein,  or  the  great  trunk,  after  it  has  as- 
cended above  the  elbow,  and  received  the  median  basilic,  is 
joined  by  several  deep  branches  of  veins,  as  those  which  ac- 
company the  brachial  artery,  called  satellites  or  comites,  a 
vein  which  is  called  profunda  brachii  ; and  still  nearer  its  de- 
termination, it  receives  the  addition  of  the  vena  subhumeralis 
or  ( irticularis , and  the  vence  scapulares , viz.  those  answering  to 
the  arteries  of  that  name. 

Vena  mediana  major. j — This  is  a vein  which  runs  up  the 
middle  of  the  fore-arm,  beginning  from  the  plexus  of  veins, 
which  play  over  the  flexor  tendons,  and  come  from  the  ball  of 
the  thumb  ; it  is  a vein  which  is  very  irregular,  being  some- 
times double,  and  sometimes  rather  in  the  form  of  a plexus, 

* Brachialis.  The  ancients  termed  the  bafilic  vein  of  the  right  arm,  the  vein 
of  the  liver,  or  vena  hepatica  brachii,  and  that  of  the  left,  the  vena  fplenica 
brachii. 

+ V erta  Media.  ■~'er.a  fvpcrficia/is  communis. 


222 


APPENDIX. 


than  to  be  considered  as  a regular  trunk  ; often  it  is  particularly 
short,  and  can  be  considered  as  a trunk,  only  for  a few  inches 
as  it  approaches  the  bend  of  the  arm  ; not  unlrequently  it  is 
entirely  wanting,  and  as  if  annihilated  by  the  preponderance 
of  the  branches  of  the  cephalic  or  basilic  vein.  But  to  take 
the  more  common  course,  as  an  example,  when  it  has  ascend- 
ed on  the  middle  of  the  fore-arm,  near  to  the  bend  of  the  arm 
it  divides  ; one  branch  passes  obliquely  outward,  and  joins 
the  cephalic  vein,  the  other  inwards  and  unites  with  the  basilic 
vein  ; the  first,  is  of  course  the  median  cephalic  vein,  the 
second,  the  median  basilic  vein. 

These  are  the  two  branches  which  the  surgeon  most  com- 
monly selects  for  bleeding.  Around  the  median  cephalic,  the 
cutaneous  nerves  play  more  profusely,  and  under  the  median 
basilic  vein  the  humeral  artery  passes.  It  is  by  the  aukward 
plunging  of  the  lancet  into  the  median  basilic,  that  the  country 
bleeder  so  frequently  produces  the  aneurism  of  the  artery  ; but 
the  dreadful  symptoms  following  the  pricking  of  the  nerve,  are 
more  frequently  produced  by  bleeding  in  the  median  cephalic ; 
cases  however  occur  of  the  pricking  of  the  nerves,  while 
bleeding  in  the  median  basilic  vein. 

Axillary  vein — Thetrunkof  the  veins  of  the  arm  pass- 
es through  the  axilla,  until  it  arrives  betwixt  the  first  rib  and 
clavicle,  under  the  name  of  axillaris.  Here  lying  by  the  side 
of  the  artery,  it  receives  many  muscular  branches  from  the 
flesh  of  the  shoulder,  the  external  and  internal  scapular  veins, 
and  the  thoracic  veins  ; in  general  where  it  passes  by  the  head 
of  the  humerus  it  receives  the  cephalic  vein. 

Subclavian  veins. — The  axillary  vein  continuing  its  pro- 
gress over  the  first  rib,  becomes  the  subclavian  vein  : on  the 
right  side  the  vein  is  shorter,  and  descends  more  obliquely  ; 
on  the  left  it  is  longer,  of  course  less  oblique,  but  still  its  di- 
rection is  downward  ; passing  before  the  trachea,  and  the 
branches  of  the  arch  of  the  aorta,  it  joins  the  subclavian  of  the 
right  side,  and  together  they  form  the  superior  cava  : the  sub- 
clavian vein  receives  these  veins,  a vein  from  the  shoulder  and 
lower  part  of  the  neck,  the  vertebral  vein,  with  some  lesser 
plexus  of  veins  descending  from  the  neck,  the  internal  jugu- 
lar vein  (and  in  the  angle  of  the  union  of  these  the  thoracic 
duct,)  and  lastly  the  th\'roid  veins.  From  below  they  receive 
the  lesser  internal  thoracic  veins. 


APPENDIX. 


263 

SECTION  III. 

THE  SUPERIOR  VENA  CAVA,  THE  VENA  AZYGOS,  AND  LES- 
SER VEINS  OF  THE  THORAX. 

The  superior  vena  cava  is  the  trunk  of  all  the  veins  of  the 
head,  neck,  arms,  and  of  the  parts  in  the  thorax  ; soon  after 
it  is  formed  by  the  subclavian  veins,  it  is  joined  by  the  vena 
azygos,  and  receiving  the  internal  mammary  veins  and 
the  VEN.E  thymicjE and  pericardiac  branches,  the  inter- 
costal and  bronchial  veins,  it  descends  into  the  pericar- 
dium, and  dilates  or  opens  into  the  right  sinus  or  auricle. 

Vena  azygos.*  This  is  the  principal  vein  of  the  thorax, 
and  chiefly  of  the  walls  of  the  thorax.  It  is  observed  to  take 
its  origin  upon  the  vertebra  of  the  loins  from  some  of  the  lum- 
bar veins,  or  by  inosculations  with  the  renal  spermatic  or  lesser 
branches  of  the  abdominal  cava,  receiving  the  first  and  second 
lumbar  veins,  as  in  its  ascent  in  the  thorax,  it  receives  the  in- 
tercostal veins  on  either  side  ; f ascending  betwixt  the  crura  of 
the  diaphragm,  and  by  the  side  of  the  aorta,  it  sometimes  re- 
ceives the  lower  phrenic  veins  ; in  the  thorax  lying  on  the 
right  side  of  the  bodies  of  the  vertebra,  and  before  intercostal 
arteries,  it  receives  the  bronchial  veins  from  the  root  of  the 
lungs,  and  from  the  trachea  it  receives  the  veins  of  the  poste- 
rior mediastinum  and  oesophagus  ; through  the  intercostal 
veins,  it  communicates  with  the  external  and  internal  mamma- 
ry veins,  and  with  the  venal  circles  of  the  spinal  marrow. 

Upon  the  third  vertebra,  the  azygos  vein  separates  from  the 
spine,  and  with  an  arch,  and  bending  round  the  root  of  the 
lungs,  it  opens  into  the  superior  cava,  just  where  it  is  about  to 
enter  the  pericardium  : where  it  opens  into  the  great  vein,  it 
is  guarded  by  a valve. 

This  vein  however,  like  most  others,  has  considerable  varie- 
ty, and  does  not  always  merit  the  name  of  azygos,  for  some- 
times it  is  double,  a division  ascending  on  the  left  side  of  the 
spine,  and  uniting  with  the  branch  of  the  other  side,  just  as  it 
is  about  to  enter  into  the  superior  cava. 

Of  the  lesser  veins  in  the  thorax — The  ven,e  mam- 
marine  take  a course  by  the  side  of  the  internal  mammary  arte- 
ry, and  require  no  description.  Like  the  arteries,  they  spread 
their  branches  on  the  muscles  of  the  bell)7,  and  communicate 

* Sine  pari. 

t We  except  feme  of  the  veins  from  the  interlaces  of  the  higher  ribs,  parti- 
cularly on  the  right  fide,  which  enter  the  fubdavian  vein. 


224 


APPENDIX. 


with  the  diaphragmatic  and  lumbar  and  epigastric‘veins.  The 
left  mammary  vein  terminates  in  the  left  subclavian  vein,  the 
right  in  the  superior  vena  cava. 

The  vfNjE  thymic^  enter,  either  into  the  union  of  the  sub- 
clavian veins,  or  they  enter  into  the  guttural  veins,  or  the  inter- 
nal mammary  veins. 

The  pericardiac  veins  gather  their  branches  from  the 
pericardium,  from  the  aorta,  trachea  and  lymphatic  glands  ; 
they  send  down  branches  by  the  side  of  the  phrenic  nerve, 
which  inosculate  with  the  veins  of  the  diaphragm  ; they  enter 
the  internal  mammary  vein,  or  the  superior  cava,  or  the  termi- 
nation of  the  right  subclavian. 

The  superior  intercostal  veins. — The  right  and  left 
intercostal  veins  differ  in  their  size  and  distribution  ; the  right 
is  small,  and  receives  only  one  or  two  of  the  upper  intercostal 
veins,  which  do  not  enter  into  the  azygos  vein.  The  vein  of 
the  left  side  begins  even  so  low  as  the  interstice  of  the  seventh 
rib  ; it  receives  branches  from  the  pleura,  pericardium  and 
lungs  (viz.  the  bronchial  veins)  and  from  the  oesophagus  } they 
enter  the  subclavian  veins. 


( 225  ) 


CHAP.  II. 


OF  THE  VEINS  WHICH  UNITE  TO  FORM  THE 
INFERIOR  VENA  CAVA. 

The  inferior  vena  cava  receives  the  veins  of  the  lower  ex- 
tremities, the  hypogastric  and  abdominal  veins,  and  the  veins 
of  the  viscera  of  the  abdomen  ; but  those  of  the  membraneous 
contents  of  the  abdomen  are  received  by  it  only  indirectly,  and 
through  the  circulation  of  the  liver. 


OF  THE  VEINS  OF  THE  LEG  AND  THIGH. 

We  have  observed  that  the  veins  of  the  extremities  are  in 
two  sets  ; the  deep  and  superficial.  In  the  leg  and  thigh  the 
deep-seated  veins  accompany  the  arteries,  and  receive  the 
same  name  : the  cutaneous  veins  are  the  saphena  major  and 
minor. 

Saphena  major.* — A large  and  beautiful  plexus  of  veins 
isfoimedon  the  fore-part  of  the  foot,  and  coming  from  the 
back  of  the  toes,  and  outside  of  the  foot.  Two  principal 
veins  arise  from  the  arch  which  these  form  : one  takes  the 
course  behind  the  inner  ankle,  and  is  the  saphena  major  ; the 
other  passes  over  the  outer  ankle,  and  forms  the  saphena  minor. 

The  great  saphena  may  be  traced  from  the  great  toe,  from 
the  inside  of  the  foot,  and  behind  the  ankle  : it  receives  one  or 
two  branches  from  the  sole  of  the  foot.  Sometimes  the  prin- 
cipal branch  passes  behind  the  lower  head  of  the  tibia,  some- 
times before  it,  or  it  forms  circles  here  : a little  above  the  an- 
kle a vein  from  the  middle  of  the  metatarsal  arch  comes  ob- 
liquely over  the  tendon  of  the  tibialis  anticus  and  joins  it. 

The  saphena,  now  a considerable  trunk,  runs  up  the  leg  be- 
fore the  inner  margin  of  the  belly  of  the  gastrocnemius  muscle, 
and  on  the  inner  ridge  of  the  tibia.  In  this  course  it  receives 
numerous  cutaneous  branches,  and  backward,  over  the  belly  of 
the  muscles,  it  forms  inosculations  with  the  lesser  saphena. 
From  the  inside  of  the  leg  the  trunk  ascends  on  the  inside  of 
the  knee,  where  it  receives  several  branches,  coming  round  the 
joint,  and  over  the  tibia.  Now  passing  somewhat  obliquely,  it 


Vol.  IV. 


* Saphena  magna,  interna. 

2 F 


226 


APPENDIX. 


ascends  upon  the  thigh,  and,  at  the  same  time,  turns  from  the 
inside  to  the  lore-part  of  the  thigh.  In  the  thigh  the  great  sa- 
phena receives  many  branches,  and  is  not  always  a single  vein  : 
for  sometimes  the  branches  collecting  form  a small  trunk,  run- 
ning collateral  to  the  greater  vein,  and  which  joins  it  in  the 
groin.  In  all  this  course  the  saphena  vein  is  superficial,  and 
lies  imbedded  in  the  cutaneous  fat ; with  but  a very  slight  and 
imperfect  aponeurosis  inclosing  it  ; while  it  is  external  to  the 
proper  fascia  of  the  leg  and  thigh.  As  it  ascends  upon  the 
thigh,  however,  it  does  not  dive  suddenly  under  the' fascia; 
but  is  gradually  enveloped  and  embraced  by  the  condensed 
cellular  membrane  and  fascia. 

When  it  was  more  the  practice  than  at  present  to  bleed  in 
the  ankle,  the  saphena  major  was  the  vein  selected  : but  as  in 
all  the  course  ol  the  vein,  from  the  great  toe  to  the  knee,  it  is 
connected  with  the  nerve  which  bears  its  name,  there  are  not 
wanting  Instances  of  those  bad  effects  from  pricking  of  the 
nerve,  which  not  unfrequently  follow  the  bleeding  in  the  arm. 

Saphena  minor.*  This  vein  arises  from  the  plexus  on 
the  outside  of  the  dorsum  pedis  : it  runs  over  .the  outer  ankle 
and  above  the  fascia,  covering  the  tendons  of  the  peronei  mus- 
cles. Here  receiving  many  branches,  and  forming  frequent 
deep  inosculations,  it  mounts  on  the  outside  of  the  vagina  or 
fascia,  which  covers  the  back  of  the  leg,  until  arriving  betwixt 
the  hamstring  tendons  it  sinks  into  the  popliteal  hollow,  termi- 
nating in  the  popliteal  vein. 

The  other  veins  of  the  lower  extremity  which  accompany  the 
arteries  in  their  course,  need  little  description. 

Anterior  tibial  vein. — The  veins  accompanying  the  an- 
terior tibia!  artery  form  many  inosculations,  and  when  minute- 
ly injected,  almost  conceal  the  artery.  They  are  the  anterior 
tibial  veins  and  only  unite  into  a trunk,  where  perforating  the 
interosseous  ligament  it  joins  the  popliteal  vein. 

Posterior  tibial  vein. — In  the  sole  of  the  foot  we  have 
the  external  and  internal  plantar  veins,  which  uniting  into 
trunks,  accompany  the  artery  behind  the  inner  ankle.  In  its 
course  betwixt  the  soleus  and  the  tibialus  anticus  muscles,  it 
cannot  be  called  the  posterior  tibial  vein  ; for  it  is  a mere  net- 
work of  veins  surrounding  the  posterior  tibial  artery.  It  re- 
ceives, near  its  termination,  a branch  called  Suralis,  from 
the  gastrocnemii  and  soleus : it  terminates  in  the  popliteal  vein. 

The  Vi  n^e  PeroneyE  are  the  vense  comites  by  the  tibial  ar- 
tery, and  are  two  or  three  in  number.  All  these  veins  have 
free  inosculations  with  each  other. 


Vena  faphena  par'ua,  externa. 


appendix. 


22 


The  Popliteal  vein. — This  vein  is  formed  by  the  three 
divisions  of  deep  veins  accompanying  the  arteries  of  the  leg, 
and  the  saphena  minor.  It  lies  more  superficial  than  the  arte- 
ry, and  seems  to  cling  round  it.  As  it  ascends,  however,  it 
twists  round  the  artery,  the  artery  being  nearest  the  bone — a 
little  above  the  joint  it  receives  the  lesser  saphena. 

This  vein,  perforating  the  tendon  of  the  triceps,  comes  to  the 
fore  part  of  the  thigh,  still  united  to  the  artery  : it  is  now  the 
crural  vein.  As  it  ascends  it  gets  from  behind  the  artery, 
so  that  in  the  groin  it  lies  nearer  the  pubes  than  the  artery  does  : 
opposite  the  trochanter  minor  it  receives  the  internal  and  ex- 
ternal circumflex  veins,  and  the  Profunda  Femoris.  About 
an  inch  below  Poupart’s  ligament  the  crural  vein  receives  the 
saphena  major,  and  the  small  external  pudic  veins. 

External  iliac  vein.  The  femoral  vein  lying  on  the 
inside  of  the  artery  or  nearer  the  pubes,  enters  the  abdomen 
under  the  femoral  ligament,  and  passing  by  the  side  of  the 
Psoas  muscle  becomes  the  external  iliac  vein.  It  receives  se- 
veral lesser  veins  just  within  the  ligament  particularly  the  epi- 
gastric vein  from  the  muscles  and  integuments  of  the  belly,  and 
the  veins  accompanying  the  arteria  circumflexa  ilii.  The  ex- 
ternal iliac  vein  is  joined  by  the  hypogastric  vein  which  as- 
cends from  the  pelvis.  It  requires  no  minute  description  ; it 
answers  to  the  distribution  of  the  hypogastric  artery.  This 
which  is  the  internal  iliac  joining  the  trunk  from  the  thigh  forms 
the  common  iliac  vein. 

Vena  cava  abdominalis.* — A little  lower  than  the  bi- 
furcation of  the  aorta,  the  right  and  left  common  iliac  veins 
unite.  By  this  union  they  form  the  vena  cava.  This  vein 
ascends  upon  the  right  of  the  aorta.  It  receives  fewer  branch- 
es than  would  naturally  be  imagined,  because  the  veins  of  the 
viscera  take  their  course  by  the  porta  into  the  liver.  It  re- 
ceives the  lumbar  veins,  the  spermatic  veins,  the  renal,  super- 
renal,  and  phrenic  veins.  Passing  upward  it  is  received  into 
its  appropriate  fossa  in  the  liver,  and  seceding  a little  from  the 
spine  it  receives  the  ven^e  cavi  hepaticyE  and  perforates 
the  diaphragm  ; entering  the  pericardium  it  expands  into  the 
great  sinus,  or  right  auricle  of  the  heart. 

Renal  veins. f — These  veins  are  less  irregular  than  the  ar- 
teries of  the  kidney,  which  relation  of  the  veins  and  arteries  is 
uncommon.  From  the  relative  situation  of  the  kidneys  to  the 
cava  it  is  evident  that  the  right  vein  must  be  short ; the  left 
comparatively  longer  and  taking  a course  from  the  kidney 
over  the  aorta.j; 

* Vena  Cana  inferior.  f Emulgent  veins. 

1 The  Renal  veins  however  fometimes  vary  in  their  number,  the  right  being 
double  or  triple,  the  left  even  fometimes  -in  four  branches 


iJ28 


APPENDIX. 


Supra-renal  veins. — These  little  veins  are  like  the  arte- 
ries in  their  course.  The  right  one  enters  sometimes  into  the 
vena  cava,  sometimes  into  the  renal  vein.  The  left  sometimes 
receives  the  phrenic  vein  of  that  side  and  enters  into  the  renal 
vein. 

Spermatic  veins. — Of  the  general  distribution  of  these 
veins  nothing  need  be  said,  after  looking  to  the  description  of 
the  arteries.* 

The  Vena  Portae  has  been  already  described  in  the  second 
volume. 

• See  page  ny. 


) 


OF  THE  TEETH. 


TT HERE  is  naturally  an  inclination  in  the  author  of  a system 
to  amplify  some  particular  subjects,  and  to  abridge,  or  bestow 
less  attention,  on  others  which  may  to  him  appear  less  interest- 
ing or  curious.  To  restrain  this  tendency  has  been  the  most 
irksome  task  which  I have  felt  in  completing  the  present  work. 
The  growth  and  structure  of  the  teeth  forms  an  elegant  and 
interesting  subject  of  inquiry  ; and  it  is  difficult  to  concentrate 
the  view  of  it  so  as  to  be  consistent  with  the  arrangement  of  a 
systematic  work. 

As  the  general  nature  and  use  of  the  teeth  are  sufficiently 
understood,  there  can  be  little  objection  to  our  beginning  the 
present  subject  with  considering  the  structure  of  the  human 
teeth. 


Of  the  structure  of  the  teeth. 

A tooth  consists  of  these  parts. — In  the  first  place,  the  ena- 
mel, a peculiarly  hard  layer  of  matter  composing  the  surface 
of  the  body  of  the  tooth.  The  internal  part,  body,  or  sub- 
stance of  the  tooth,  is  less  stony  and  hard  than  the  enamel, 
but  of  a firmer  structure  and  more  compact  than  common  bone. 
In  regard  to  the  form  of  the  tooth,  we  may  observe  that  it  is 
divided  into  the  crown,  neck,  and  fangs,  or  roots  of  the  tooth, 
which  go  deep  into  the  jaw.  There  is  a cavity  in  the  body  of 
the  tooth,  and  the  tube  of  the  fangs  communicates  with  it. 
This  cavity  receives  vessels  for  supplying  the  remains  of  that 
substance  upon  which  the  tooth  was  originally  formed.  The 
roots  of  the  teeth  are  received  into  the  jaw  by  that  kind  of  ar- 
ticulation which  was  called  gomphosis.  They  are  not  firmly 
wedged  into  the  bone,  for,  in  consequence  of  maceration,  and 
the  destruction  of  the  soft  parts,  the  teeth  drop  from  the  scull. 
There  is  betwixt  the  tooth  and  its  socket  in  the  jaw  a common 
periosteum. 

Of  the  enamel.  The  surface  of  a tooth,  that  which  ap- 
pears above  the  gum,  is  covered  with  a very  dense  hard  layer 
of  matter,  which  has  been  called  the  enamel.  In  this  term 
there  is  some  degree  of  impropriety,  as  assimilating  an  animal 


230 


appendix. 


production  with  a vitreous  substance,  although  the  enamel 
very  widely  differs  from  the  glassy  fracture  when  broken.  This 
matter  bestows  the  most  essential  quality  of  hardness  on  the 
teeth  ; but  it  is  probably  useful  in  another  way,  being  interme- 
diate betwixt  the  central  bony  part  of  the  tooth,  which  has  life, 
and  is  subject  to  disease,  and  matter  altogether  foreign  to  the 
living  body.  When  the  enamel  is  broken  off,  and  the  body  of 
the  tooth  exposed,  it  quickly  decays. 

The  enamel  is  the  hardest  production  of  the  animal  body. 
It  strikes  fire  with  steel : in  church-yard  sculls  it  is  observed  to 
resist  decay  when  the  centre  of  the  tooth  has  fallen  into  dust. 
It  has  been  found  that  the  component  parts  of  the  enamel  are 
nearly  the  same  with  those  of  bone  : in  bone  the  phosphate  of 
lime  is  deposited  on  the  membranes,  or  cartilage,  but  this 
hardening  matter  of  bones  is  a secretion  from  the  vessels  of  the 
part,  and  is  accumulated  around  the  vessels  themselves  : it  is 
still  within  the  controul  of  their  action,  and  is  suffering  the 
succession  of  changes  peculiar  to  a living  part.  But,  in  the 
enamel,  the  phosphate  of  lime  has  been  deposited  in  union 
with  a portion  of  animal  gluten,  and  has  no  vascularity,  nor 
does  it  suffer  any  change  from  the  influence  of  the  living  sys- 
tem. Although  the  hardening  matter  be  principally  phosphate 
of  lime,  a small  proportion  of  the  carbonate  of  lime  enters 
into  the  composition  both  of  bone  and  of  enamel. 

Although  we  call  the  earthy  deposit  the  hardening  matter, 
yet  it  is  the  union  of  the  glutinous  matter  which  bestows  the 
extreme  hardness,  for,  when  the  tooth  is  as  yet  within  the  jaw, 
and  in  an  early  stage  of  its  formation,  the  deposition  is  soft, 
and  its  surface  rough  ; but,  by  a change  in  the  surface,  which 
throws  out  this  secretion,  the  first  deposition  is  penetrated  with 
gelatinous  secretion,  which,  either  by  this  penetration  simply, 
or  by  causing  a new  apposition  of  its  parts,  (its  structure  in- 
deed looks  like  crystallization,)  bestows  the  density  and  ex- 
treme hardness  on  this  crust.  When  an  animal  is  fed  with 
madder,  the  colouring  matter  coming,  in  the  course  of  the 
circulation,  in  contact  with  the  earth  of  bone,  is  attracted  by 
it,  and  is  deposited  upon  it  in  a beautiful  red  colour.  This 
colouring  matter  penetrates  more  than  injection  can  be  made 
to  do  in  the  dead  body  ; and,  as  by  this  process  of  feeding, 
the  enamel  is  not  tinged,  we  have  a convincing  proof  that  the 
vascular  system  has  no  operation  on  the  enamel  after  it  is 
formed. 

From  the  composition  of  the  enamel,  we  must  be  aware 
of  the  baneful  effects  of  acidulated  washes  and  powders  to  the 
teeth : they  dissolve  the  surface,  and  give  a deceitful  whiteness 


OF  THE  TEETH. 


231 


to  the  teeth  ; they  erode  the  surfacfe,  which  it  is  not  in  the  con- 
stitution of  the  part  to  restore. 

Of  the  central  bony  part  of  the  tooth.  The  che- 
mical composition,  and  the  manner  of  combination  of  the 
matter  forming  the  central  part  of  the  tooth,  and  of  the  fangs, 
is  similar  to  the  other  bones  of  the  body  ; but  when  we  exam- 
ine the  hardness  and  the  density  of  the  tooth,  and  see  that  it  is 
not  even  porous,  or  apparently  capable  of  giving  passage  to 
vessels,  we  doubt  of  its  vascularity,  and  are  apt  to  suppose 
that  it  holds  its  connection  with  the  living  jaw-bone  by  some 
other  tenor  than  that  of  vessels,  and  the  circulation  of  the 
blood  through  it.  I must  acknowledge  that  the  difficulty  in 
deciding  on  the  vascularity,  and  degree  of  vitality  which  the 
teeth  possess,  appears  to  me  so  great,  that  I shall  at  present 
venture  to  give  no  decided  opinion.  The  vascularity  of  the 
periosteum,  which  surrounds  the  teeth  and  vessels  which  enter 
by  the  fangs  to  the  cavity  of  the  teeth,  seemed  to  shew  a 
sedulous  care  to  supply  the  tooth  plentifully  with  blood.  As 
this  part  of  the  tooth  has  often  been  colourecLby  feeding  young- 
animals  with  madder,  the  reverse  of  that  experiment,  which 
convinces  us  there  is  no  circulation  in  the  enamel,  should  satisfy 
us  that  there  is  blood  circulating  through  the  body  of  the 
tooth,  and  that  it  undergoes  the  same  changes  by  absorption 
which  the  other  bones  are  proved  to  do  ; but  these  experiments 
may  have  been  made  while  the  teeth  were  forming  by  the  de- 
position from  the  pulp,  and  of  course  they  might  be  coloured 
without  the  experiment  affording  a fair  proof  that  the  circula- 
tion continues  in  the  tooth  after  it  is  formed.  If  it  be  proved 
that  the  adult  teeth,  or  a fully  formed  tooth  yet  within  the 
jaw,  are  uniformly  tinged  with  the  madder,  we  must  without 
reserve  conclude,  that  the  economy  of  the  teeth  is  in  all  re- 
spects like  that  of  the  common  bones. 

The  teeth  undergo  changes  of  colour  in  the  living  body,  to 
which  it  would  appear  they  could  not  be  liable  as  dead  matter. 
They  become  yellow,  transparent,  and  brittle  with  old  age  ; 
and  when  a tooth  has  been  knocked  from  its  socket,  and  re- 
placed, dentists  have  observed  that  it  loses  its  w'hiteness,  and 
assumes  a darker  hue. 

The  absorption  of  the  roots  in  consequence  of  the  caries  of 
the  body’  of  the  tooth,  and  the  absorption  of  the  fangs  of  the 
deciduous  teeth,  are  further  alleged  in  proof  of  their  vascu- 
larity ; not  only  the  pressure  of  the  rising  tooth  on  the  fangs  of 
the  temporary  teeth  will  cause  an  absorption  of  the  latter,  but 
the  fangs  of  the  temporary  teeth  will  waste  and  be  absorbed, 
so  as  to  drop  out  without  the  mechanical  pressure  of  the  per- 


232 


APPENDIX. 


manent  teeth,  and  before  they  have  advanced  to  be  in  contact 
with  the  former. 

The  teeth  seem  acutely  sensible,  but  a little  consideration 
teaches  us  that  the  hard  substance  of  the  teeth  is  not  endowed 
with  sensibility,  and  that  it  must  be  the  remains  of  the  vascular 
pulp,  presently  to  be  described,  occupying  the  centre  of  the 
tooth,  which  being  supplied  with  nerves,  gives  the  acute  pain 
in  tooth-ach.  It  is  as  a medium  communicating  or  abstracting 
heat,  that  the  tooth  itself  seems  to  give  pain.  When  wrought 
upon  by  the  dentist,  no  sensation  is  produced  unless  the  tremor 
be  communicated  to  the  jaw,  or  unless  the  abrading,  or  cutting- 
instruments,  be  so  plied  as  to  heat  the  tooth  : then  an  acute 
pain  is  produced  from  the  heat  communicated  to  the  centre  ; 
and  so,  extremely  cold  substances,  or  liquids,  taken  into  the 
mouth,  still  produce  pain,  from  the  cold  affecting  the  pulp  of 
the  tooth. 

As  living  parts,  the  teeth  have  adhesion  to  the  periosteum, 
and  are  connected  with  their  internal  pulp  ; but  when  they 
spoil,  and  are  eroded,  the  disease  spreads  inwardly,  probably 
destroying  the  life  of  the  bony  part  of  the  tooth,  the  progress 
of  which  disease  is  marked  by  a change  of  colour  penetrating 
beyond  the  caries  towards  the  centre  of  the  tooth.  When  this 
discolouration  has  reached  the  internal  surface,  the  pain  of 
tooth-ach  is  excited,  the  pulp,  vascular  and  supplied  with 
nerves,  inflames,  from  a want  of  accordance  with  the  altered 
state  of  the  tooth,  just  as  the  dead  surface  of  a bone  will  inflame 
the  central  periosteum  and  marrow.  The  extreme  pain  pro- 
duced by  this  state  of  the  tooth  probably  proceeds  from  the  de- 
licate and  sensible  pulp  swelling  in  the  confinement  of  the  ca- 
vity of  the  tooth. 

In  caries  of  the  teeth,  the  body  of  the  tooth  is  discovered 
deep  in  its  substance  long  before  the  pulp  of  the  central  cavity 
is  exposed  by  the  progress  of  the  caries.  No  exfoliation,  or 
exostosis,  takes  place  upon  that  part  of  the  tooth  which  is  above 
the  gum,  which  may  be  owing  to  the  mere  compactness  of  the 
ossific  depositions,  for  we  know  that  the  bones  ot  greatest 
density  are  the  most  apt  to  yield  altogether  to  diseased  action, 
and  die,  instead  of  throwing  off  their  surface,  in  exfoliations, 
or  taking  any  other  variety  of  diseased  action. 

In  the  further  consideration  of  this  subject,  there  are  cir- 
cumstances which  will  make  us  doubt  of  there  being  vascular 
action  in  the  teeth,  and  perhaps  incline  us  to  believe  that  they 
possess  a lower  degree  of  life,  and  are  less  subject  to  change 
than  other  parts.  Supposing  the  bonv  part  of  the  tooth  to  be 
vascular,  and  to  possess  the  principle  of  life,  is  not  the  firm 
adhesion  and  contact  of  the  enamel  to  the  body  of  the  tooth  a 


OF  THE  TEETH. 


233 


curious  instance  of  a part  destitute  of  life  adhering  to  the  sur- 
face of  a living  part,  without  producing  the  common  effects  of 
excitement  and  exfoliation,  or  inflammation,  in  the  latter  ? Is 
the  enamel,  though  not  a vascular  part,  possessed  of  some  qua- 
lity which  distinguishes  it  from  foreign  matter,  or  is  the  bony 
part  of  the  tooth  possessed  of  so  low  a degree  of  vascular  ac- 
tion, that  it  is  not  excited  by  the  contact  and  adherence  of  the 
enamel  ? We  must  suppose  that  some  accordance  subsists  be- 
tween them  from  what  is  observed  to  be  the  effect  of  the  loss 
of  the  enamel,  for  then  the  bone  of  the  tooth  spoils  rapidly, 
and  becomes  carious. 

In  rickets,  and  mollifies  ossium,  and  other  diseases  of  de- 
bility in  which  the  body  wastes,  or  the  growth  is  retarded,  the 
growth  of  the  teeth  is  not  retarded  in  the  one  case,  nor  are  the 
grown  teeth  altered  in  their  form  or  properties  in  the  other. 
This  appears  to  me  to  support  the  idea  of  there  being  a distinc- 
tion in  the  economy  between  the  manner  of  the  formation  of 
the  teeth,  and  of  common  bone.  The  effects  which  we  per- 
ceive in  the  bony  system  under  these  diseases,  are  produced 
by  a preponderance  of  the  absorbents  over  the  activity  of  the 
secreting  vessels  ; while  in  the  teeth  no  such  effect  can  take 
place  if  they  are  formed  by  a deposition  of  bony  matter  which 
is  not  re-absorbed,  nor  undergoes  the  revolution  of  deposition 
and  re-absorption,  as  in  other  parts  of  the  body  is.  the  case. 
Accordingly  we  find  in  rickets,  and  the  mollifies  ossium,  where 
the  hardest  bone  yields,  where  the  jaw-bone  itself  is  distorted 
or  altered  in  its  form,  that  the  teeth  remain  distinguished  for 
their  size  and  beauty  ; and  in  rickets  the  teeth  are  large,  and 
perfectly  formed,  while  the  jaws  are  stinted  and  interrupted 
in  their  growth.  The  consequence  of  this  is,  that  the  teeth 
form  a larger  range  than  the  jaw,  and  give  a characteristic  pro- 
tuberance to  the  mouth. 

The  roots  of  the  teeth  are  sometimes  found  enlarged,  dis- 
torted, or  with  exostosis  formed  upon  them.  Again  the  ca- 
vity of  the  tooth  is  found  to  have  been  filled  up  with  the  for- 
mation of  new  matter,  or  around  the  fangs  we  often  find  a 
small  sac  of  pus,  which  is  sometimes  drawn  out  in  extracting 
the  tooth.  Nevertheless,  in  these  examples  of  disease,  there 
are  no  unequivocal  marks  of  vascular  action  in  the  teeth  ; the 
unusual  form,  or  exostosis  of  the  roots,  is  produced  by  an  ori- 
ginal defect  in  the  formation.  The  filling  up  of  the  cavity  of 
the  tooth  is  caused  by  the  resumed  ossific  action  of  the  pulp  in 
consequence  of  the  disease  and  destruction  of  the  body  of  the 
tooth  ; and  the  abscesses  which  surround  the  fangs  are  caused 
by  the  death  of  the  tooth,  in  consequence  of  which  it  has  lost 
Vox..  IV.  2 G 


234 


APPENDIX. 


its  sympathy  with  the  surrounding  living  parts,  and  becomes 
a source  of  irritation  like  any  other  foreign  body. 

We  must  conclude,  that  the  whole  phenomena  displayed  in 
the  formation,  adhesion,  and  diseases  of  the  teeth,  show  them 
to  be  possessed  of  life,  and  that  they  have  a correspondence, 
or  sympathy  with  the  surrounding  parts.  But  are  we  prepar- 
ed to  acquiesce  in  the  opinion  of  Mr.  Hunter,  that  they  pos- 
sess vitality  while  yet  they  have  no  vascular  action  within 
them  ? We  naturally  say,  how  can  such  vitality  exist  inde- 
pendently of  a circulation  ? But  there  are  not  wanting  exam- 
ples of  an  obscure  and  low  degree  of  life  existing  in  animals’ 
ova,  or  seeds,  for  seasons  without  a circulation  ; and  if  for 
seasons,  why  not  for  a term  of  life?  We  never  observe  the 
animal  economy  providing  superfluously,  and  since  there  is  no 
instance  to  be  observed  in  which  the  teeth  have  shown  a power 
of  renovation,  why  should  they  be  possessed  of  vascularity 
and  action  to  no  useful  end  ? All  that  seems  necessary  to 
them  is,  that  they  should  firmly  adhere  without  acting  as  a 
foreign  and  extraneous  body  to  the  surrounding  parts,  and  this, 
vitality  without  vascular  action,  seems  calculated  to  provide, 

OF  THE  FORMATION  AND  GROWTH  OF  THE  TEETH. 

In  the  <jaws  of  a child  newly  born,  there  are  contained  two 
set  of  teeth  as  it  were  in  embryo  : the  deciduous,  temporary, 
or  milk  teeth  ; and  the  permanent  teeth.  The  necessity  for 
this  double  set  of  teeth  evidently  is  to  be  found  in  the  incapaci- 
ty of  alteration  of  shape  or  size  in  the  teeth  as  in  other  parts  of 
the  body  ; the  smaller  teeth,  which  rise  first,  and  are  adapted 
to  the  curve  and  size  of  the  jaw-bone  of  an  infant,  require 
to  be  succeeded  by  others,  larger,  stronger,  and  carrying  their 
roots  deeper  in  the  jaw. 

Each  tooth  is  formed  in  a little  sac,  which  lies  betwixt  the 
plates  of  bone  that  form  the  jaw-bone  of  the  foetus,  or  child, 
under  the  vascular  gum,  and  connected  with  it. 

When  we  open  one  of  these  sacs  at  an  early  period  of  the 
formation  of  the  tooth,  a very  curious  appearance  presents  it- 
self : a little  shell  of  bone  is  seen  within  the  sac,  but  no  ena- 
mel is  yet  formed.  Upon  raising  the  shell  of  bone,  which  is 
of  the  shape  of  the  tooth,  and  is  the  outer  layer  of  the  bony 
substance  of  the  tooth,  a soft  vascular  stool,  or  pulp,*  is  found' 
to  have  been  the  mould  on  which  this  outer  layer  of  ossifi'c  mat- 
ter has  been  formed  ; and  a further  observation  will  lead  us  to 
conclude  that  this  bony  and  central  part  of  the  tooth  is  in  the 


Lc  noyau,  la  coque,  or  le  germc  de  la  dent,  by  the  French  authors. 


OF  THE  TEETH. 


235 


progress  of  being  formed  by  successive  layers  of  matter  thrown 
out  from  the  surface  of  this  vascular  pulp  ; though  many  have 
explained  the  formation  of  the  tooth,  by  supposing  that  the 
layers  of  this  pulp  were  successively  ossified. 

If  we  now  turn  our  attention  to  the  state  of  those  teeth  which 
we  know  to  be  later  of  rising  above  the  gum,  we  shall  find  the 
ossification  still  less  advanced,  and  a mere  point,  or  perhaps 
several  points  of  the  deposited  matter  on  the  top  of  the  pulp. 

The  pulp,  or  vascular  papilla  on  which  the  tooth  is  formed, 
has  not  only  this  peculiar  property  of  ossification,  but,  as  the 
period  of  revolution  advances,  where  it  forms  the  rudiments  of 
the  molares  for  example,  its  base  splits  so  as  to  form  the  mould 
of  two,  three,  or  four  fangs,  or  roots  ; for  around  these  divisions 
of  the  pulp  the  ossific  matter  is  thrown  out  so  as  to  form  a tube 
continued  downward  from  the  body  of  the  tooth.  Gradually, 
and  by  successive  layers  of  matter  on  the  inside  of  this  tube,  it 
becomes  a strong  root  or  fang,  and  the  bony  matter  has  so  en- 
croached on  the  cavity,  that  only  a small  canal  remains,  and  the 
appearance  of  the  pulp  is  quite  altered,  having  shrunk  in  this 
narrow  space. 

We  have  said  that  the  tooth  forming  on  its  pulp,  or  vascular 
bed,  is  surrounded  with  a membrane  giving  the  whole  the  ap- 
pearance of  a little  sac.  This  membrane  has  also  an  important 
use.  It  is  vascular  also  as  the  pulp  is,  but  it  is  more  connect- 
ed with  the  gums,  and  receives  its  vessels  from  the  surface, 
while  the  pulp,  lying  under  the  shell  of  the  tooth,  receives  its 
blood-vessels  from  that  branch  of  the  internal  maxillary  artery 
which  takes  its  course  in  the  jaw. 

The  enamel  is  formed  after  the  body  of  the  tooth  has  consi- 
derably advanced  towards  its  perfect  form.  It  is  formed  by  a 
secretion  from  the  capsule,  or  membrane  which  invests  the 
teeth,*  and  which  is  originally  continuous  with  the  pulp.  The 
enamel  is  thicker  at  the  point,  and  on  the  body  of  the  tooth, 
than  at  its  neck.  Mr.  Hunter  supposed  that  the  capsule  always 
secreting,  and  the  upper  part  of  the  tooth  being  formed  first,  it 
would  follow  of  course  that  the  point  and  body  of  the  tooth 
would  be  covered  with  a thicker  deposition  ; but  it  rather  ap- 
pears that  the  part  of  the  sac  opposite  to  the  upper  part,  and 
body  of  the  tooth,  has  a greater  power  of  secreting,  being  in 
truth  more  vascular  and  spongy,  for  the  whole  of  the  body  of 
the  bony  part  of  the  tooth  is  formed  before  the  enamel  invests 
the  tooth. 

We  are  indebted  to  M.  Herissant  for  much  of  the  explana- 

* This  outer  fac  has  been  called  chorion,  from  the  numerous  veflels  diftributed 
upon  it.  See  HerilTant. 


236 


APPENDIX. 


tion  of  the  manner  in  which  the  enamel  is  formed.  He  de- 
scribes the  sac,*  its  attachment  to  the  pulp,  and  to  the  neck  of 
the  teeth  — as  the  tooth  advances  to  its  perfect  form,  the  sac 
also  changes.  At  first  it  is  delicate  and  thin,  but  it  thickens 
apace.  And  he  asserts,  that  if  after  this  progress  is  begun  you 
examine  the  inner  surface  of  it  with  a glass,  you  will  perceive 
it  to  be  composed  of  little  vesicles  in  regular  order,  and  which 
sometimes  have  a limpid  fluid  contained  in  them.  This  liquid 
exuded  upon  the  surface  of  the  teeth  he  supposes  to  form  the 
enamel.  He  explains  also  how  this  sac,  originally  investing 
the  body  and  neck  oi  the  tooth,  being  pierced  by  the  edge  of 
the  tooth,  and  the  tooth  rising  through  it,  is  inverted,  and  by 
still  keeping  its  connection  with  the  circle  of  the  crown  of  the 
tooth,  rises  up  in  connection  with  the  gum,  and  in  some  degree 
forms  the  new  gum  which  surrounds  the  tooth. 

Succeeding  authors  have  found  this  membrane  double.  We 
may  examine  it  most  successfully,  says  Mr.  Hunter,  in  a new- 
born child,  and  we  find  it  made  up  oi  two  lamellae,  an  external 
and  an  internal ; the  external  is  soft  and  spongy,  without  any 
vessels  ; the  other  is  much  firmer,  and  extremely  vascular,  its 
vessels  coming  from  those  that  are  going  to  the  pulp  of  the 
tooth.  He  acids,  that  while  the  tooth  is  within  the  gum,  there 
is  always  a mucilaginous  fluid  like  the  sinovia  in  the  joints  be- 
tween this  membrane  and  the  pulp  of  the  tooth. 

Of  the  growth  of  the  second  set  of  teeth,  and  the 

SHEDDING  OF  THE  FIRST  SET. 

The  first,  or  deciduous  set  of  teeth,  being  adapted  only  for 
the  jaws  of  a child,  are  destined  to  be  shed,  and  to  give  place 
to  the  adult,  or  permanent  set  of  teeth.  Accordingly,  in  ob- 
serving the  progress  of  the  formation  of  the  first  teeth,  the  ru- 
diments of  the  second  may  also  be  seen  in  the  foetus  of  the 
seventh  or  eighth  month  : and  in  the  fifth  and  sixth  month  after 
birth,  the  ossification  begins  in  them.  The  rudiments  of  the 
permanent  teeth  maybe  observed  even  when  the  sac  is  very  small, 
and  appear  like  a filament  stretching  up  to  the  neck  of  the  sac  of 
the  deciduous  teeth.  These  sacs  lie  on  the  inner  side  of  the 
jaw-bone,  and  when  further  advanced,  the  necks  of  the  two 
sacs,  (both  as  yet  under  the  gum)  are  united  ; but  when  the 
first  teeth  are  fully  formed,  and  have  risen  above  the  gum,  the 
alveolar  processes  have  been  at  the  same  time  formed  around 
them,  and  now  the  sac  of  the  permanent  teeth  have  a connec- 


Reffemble  affez  a une  petite  bourfe  fertnee. 


OF  THE  TEETH. 


237 


tion  with  the  gums  through  a small  foramen  in  the  jaw-bone, 
behind  the  space  through  which  the  first  teeth  have  shot. 

The  opinion  now  entertained,  that  the  second  set  of  teeth 
pushes  out  the  first,  is  very  erroneous,  for  the  change  on  the  de- 
ciduous and  the  growing  teeth  seems  to  be  influenced  by  laws 
of  coincidence  indeed,  but  not  of  mechanical  action.  Some- 
times we  observe  the  falling  tooth  wasted  at  the  root,  or  on  the 
side  of  the  fang,  by  the  pressure  of  the  rising  tooth.  Now 
here  vve  should  suppose  that  the  newly-formed  tooth  should  be 
the  most  apt  to  be  absorbed  by  the  pressure  of  the  root  of  the 
deciduous  tooth,  did  we  not  recollect  that  the  new  tooth  is  in- 
vested with  the  hard  enamel,  while  the  pressure  on  the  other 
acts  upon  the  bony  root.  But  there  is  more  than  this  in  the 
phenomenon  of  the  shedding  of  the  teeth,  for  often  the  fang  is 
wasted  while  the  tooth  adheres  only  by  the  gum,  and  the  per- 
manent tooth  has  made  little  progress  in  its  elevation,  and  has 
not  pressed  upon  it.  This  decay  and  wasting  of  the  fangs  of 
the  teeth  looks  more  like  a satisfactory  proof  in  support  of  their 
vascularity,  than  any  other  change  to  which  they  are  subject. 

Yet  there  seems  to  be  no  reason  why  we  should  not  suppose, 
that  as  the  rudiments  of  the  teeth  rise  into  action  at  a particu- 
lar time,  and  form  the  bony  centre  of  the  tooth,  this  formation 
should  be  affected  by  similar  laws  ; that  at  a particular  period 
the  tooth  should  decay,  and  that  the  decay  of  the  tooth  should 
begin  with  the  destruction  of  the  fangs.  Neither  can  I resist 
the  belief  that  the  bony  part  of  the  tooth  has  a tendency  to 
dissolution  independently'  of  a circulation  of  blood  through  it, 
or  of  an  internal  action  of  vessels,  and  that  as  the  roots  waste, 
the  surrounding  vascular  parts  absorb  its  substance. 

It  is  no  proof  of  the  first  set  being  pushed  out  bv  the  second 
set  of  teeth,  that  if  the  permanent  teeth  do  not  rise,  the  first 
will  remain,  their  roots  unwasted  and  firm  even  to  old  age  ; 
for  still  I contend  that  there  is  an  agreement  and  coincidence 
betwixt  the  teeth  in  their  changes,  and  also  in  the  alveoli,  by 
which  they  are  surrounded  ; but  this  is  not  produced  bv  the 
pressure  of  the  rising  teeth.  When  a dentist  sees  a tooth 
seated  out  of  the  proper  line,  and  draws  it,  and  finds  that  he 
has  made  the  mistake  of  extracting  the  adult  tooth,  letting  the 
milk  tooth  remain,  he  must  not  expect  that  the  milk  tooth  will 
keep  its  place,  for  the  contrary  will  happen,  it  will  in  general 
fall  out. 

The  old  and  the  new  teeth  are  lodged  in  distinct  compart- 
ments of  the  jaw-bone,  and  what  is  more  curious,  their 
alveoli  are  distinct,  for  as  the  roots  of  the  first  teeth  decay, 
their  alveolar  processes  are  absorbed,  while  again,  as  the  new 
teeth  rise  from  their  deep  seat  in  the  jaw-bone,  they  are  ac- 


238 


APPENDIX. 


companied  with  new  alveoli  ;*  yet  these  alveoli  are  not  suffi- 
cient to  support  the  teeth,  for  we  find  that  the  teeth  will  remain 
long  perfect  while  they  uniformly  retain  their  relative  position 
and  number,  but  when  one  falls,  the  rest  more  quickly  decay  ; 
and  the  chief  art  of  the  dentist  in  shifting  the  seat  of  the  teeth, 
is  gradually  to  push  them  along  the  jaw  notwithstanding  these 
bony  partitions  and  processes,  so  as  to  bring  them  into  equal 
and  seemly  lines. 

No  circumstance  can  better  illustrate  how  perfect  the  de- 
pendence of  the  alveoli  is  upon  the  teeth,  than  that  of  their 
being  thrown  off  with  them  in  extensive  exfoliations.  I have 
a specimen  of  this  in  my  collection,  where  the  whole  circle  of 
the  alveolar  processes  and  teeth  is  thrown  off.  This  happened 
after  the  confluent  small-pox.  I think  I recollect  a similar 
case  occurring  to  Dr.  Blake.  In  those  tumours  which  arise 
from  the  alveoli  and  gums,  filling  the  mouth  with  a cancerous 
mass,  and  softening  the  upper  part  of  the  jaw,  there  is  no 
eradicating  the  disease  but  by  taking  away  the  whole  adventi- 
tious part  of  the  jaw  which  belongs  to  the  teeth,  and  leaving 
only  the  firmer  base.  But  even  this  operation  will  be  too  often 
unsuccessful. 

When  a tooth  is  lost,  it  appears  as  if  the  space  it  occupied 
were  partly  filled  up  by  an  increased  thickness  of  the  adjacent 
teeth,  and  partly  by  the  lengthening  of  that  which  is  opposite  : 
indeed,  this  appearance  has  been  brought  as  a proof  of  the 
continual  growth  of  teeth.  But  there  is  a fallacy  in  the  obser- 
vation ; for  w hen  the  space  appears  to  have  become  narrow  by 
the  approximation  of  the  two  adjacent  teeth,  it  is  not  owing  to 
any  increase  of  their  breadth,  but  to  their  moving  from  that 
side  where  they  are  well  supported  to  the  other  side  where  they 
are  not.  For  this  reason  they  get  an  inclined  direction  ; and 
this  inclination  may7  be  observed  in  several  of  the  adjoining 
teeth. j 

The  transplanting  of  teeth  presents  another  very  interesting 
phenomenon.  A tooth  recently  drawn,  and  placed  accurately 
into  a socket  from  which  one  has  been  taken,  will  adhere  there : 
nay,  it  will  even  adhere  to  any  living  part,  as  in  the  comb  of  a 
cock.  This,  however,  proves  nothing  further  than  what  all 
allow,  that  the  tooth  possesses  vitality,  for  after  a time  it  w ill 
not  adhere  ; it  has  become  a dead  part,  and  the  living  sub- 
stance refuses  to  coalesce  with  it.  Again,  and  in  opposition 
to  this,  is  it  not  very  extraordinary  that  the  teeth  may  be 
burnt  by  chemical  agents,  or  the  actual  cautery,  down  to  the 

* Mr.  Hunter, 
f Mr.  J.  Hunter. 


OF  THE  TEETH. 


239 


centre,  and  yet  retain  their  hold  ; or  that  the  body  of  the 
tooth  may  be  cutoff,  and  a new  tooth  fixed  into  it  by  a. pivot  ? 
Had  the  teeth  any  vascular  action,  this  torturing  would  cause 
re-action  and  disease  in  them.  Sometimes  the  most  terrible 
effects  are  produced  bv  these  operations,  as  tetanus,  abscess  in 
the  jaws,  &c.  ; but  this  happens  in  consequence  of  the  central 
nerve  being  bruised  by  the  wedging  of  the  pivot  in  the  cavity 
of  the  tooth,  or  by  the  roots  of  the  teeth  becoming,  as  dead 
bodies,  a source  of  irritation  to  the  surrounding  sockets. 

The  disease  produced  by  the  transplanting  of  teeth  has  not 
been  satisfactorily  explained,  though  the  investigation  would 
throw  considerable  light  on  the  physiology  of  the  teeth,  and  be 
in  itself  of  practical  use. 

About  a month  after  transplanting  the  tooth,  and  after  it  has 
taken  perfect  adhesion,  the  disease  has  appeared.  An  ulcera- 
tion is  perceived  in  the  gum  and  jaw  ; or  the  gum  shrinking 
and  wasting  by  ulceration,  leaves  the  tooth  and  alveoli  bare. 
Soon  after,  blotches  appear  on  the  skin  ; and  sometimes  ulcers 
in  the  throat. — In  some  cases,  this  disease  has  been  cured 
without  mercury,  and  in  others,  seems  only  to  have  yielded  to 
the  mercurial  course.  Mr.  Hunter  entertained  the  opinion 
that  it  was  not  venereal,  but  a distinct  disease  ; and  I find  that 
Richter  supposes  there  are  two  diseases  produced,  the  one  ve- 
nereal, and  the  other  a peculiar  affection.  Others  have  suppos- 
ed that  this  is  not  a disease  propagated  from  the  one  person  to 
the  other,  but  produced  by  the  combination  of  the  living  prin- 
ciple of  two  distinct  systems  ! In  short,  the  case  does  not 
seem  to  be  well  understood.  Supposing  it  to  be  the  venereal 
disease  thus  propagated,  (and  this  is  the  most  likely  sugges- 
tion,) then  it  does  not  appear  that  we  should  consider  it  as  an 
inoculation  of  the  matter  of  the  disease,  but  of  a part  long  con- 
taminated, ingrafted  : and  in  this  view  it  will  probably  be 
found  necessary  to  continue  the  plan  of  cure  as  for  an  old  affec- 
tion, and  not  for  the  recent  disease. 

We  may  conclude  that  the  teeth  are  peculiar  in  their  sub- 
stance and  structure,  in  the  manner  of  their  growth  and  nutri- 
tion ; and,  as  they  are  distinct  from  the  other  bones  of  the  sys- 
tem in  their  form  and  connections,  so  are  they  in  their  more 
essential  qualities. 

Of  the  gums. — The  necks  of  teeth  are  surrounded  by  the 
gums,  a red,  vascular,  but  firm  substance  which  covers  the 
alveolar  processes.  To  the  bone  and  to  the  teeth  the  gums  ad- 
here very  strongly,  but  the  edge  touching  the  teeth  is  loose. 
The  gums  have  little  sensibility  in  their  healthy  and  sound 
state  ; and  by  mastication,  when  the  teeth  are  lost,  they  gain  a 
degree  of  hardness  which  proves  almost  a substitute  for  the 


240 


APPENDIX. 


teeth.  The  use  of  the  gum  is  chiefly  to  give  firmness  to  the 
teeth,  and  at  the  same  time,  as  Mr.  Hunter  observes,  to  give 
them  that  kind  of  support  which  breaks  the  jar  of  bony  con- 
tact. Like  the  alveolar  process,  the  gums  have  a secret  con- 
nection with  the  state  of  the  teeth.  Before  the  milk-teeth  ap- 
pear, there  is  a firm  ridge  which  runs  along  the  gums,*  but  this 
is  thrown  off,  or  wastes  with  the  rising  of  the  teeth : and  as  the 
teeth  rise  the  proper  gums  grow,  and  embrace  them  firmly. 
The  gum  is  firm,  and  in  close  adhesion,  when  the  teeth  are 
healthy  ; loose,  spongy,  or  shrunk,  when  they  are  diseased. 
The  only  means  of  operating  upon  the  general  state  of  the  teeth 
is  through  the  gums  ; and  by  keeping  them  in  a state  of  healthy 
action  by  the  brush  and  tinctures,  the  dentist  fixes  the  teeth, 
and  preserves  them  healthy  ; but  when  they  are  allowed  to  be 
loose  and  spongy,  and  subject  to  frequent  bleeding,  (which  is 
improperly  called  a scorbutic  state,)  the  teeth  become  loose, 
and  the  gums  painful.  If  a healthy  tooth  be  implanted  in  the 
jaw,  the  gum  grows  up  around  it,  and  adheres  to  it ; but  if  it 
be  dead  or  diseased,  the  gum  ulcerates,  loosens,  and  shrinks, 
from  it ; and  this  shrinking  of  the  gums  is  soon  followed  by 
the  absorption  of  the  alveoli. 

From  the  disorder  of  the  teeth,  the  gums  are  subject  to 
many  diseases  ; some  of  them  troublesome,  some  dangerous, 
or  at  least  giving  rise  to  dangerous  diseases.  They  swell  from 
tooth-ach  and  inflammation  of  the  centre  of  the  tooth  (parulis,) 
or  form  tumours  from  the  side  of  the  tooth  (epulis.)  Often 
suppuration  follows  these  swellings  ; and  the  matter  making  its 
way  by  the  side  of  the  jaw,  and  destroying  the  alveoli,  trouble- 
some fistulie  are  the  consequence.  The  accumulation  of  tartar 
on  the  teeth  is  the  cause  of  an  ulceration  and  wasting  of  the 
gums,  in  the  end  very  injurious  to  the  teeth.  The  soft,  spon- 
gv,  and  bleeding  tumours  wrhich  arise  from  the  gums,  are  in 
fact  diseases  of  the  bone,  or  rather  the  peculiar  characteristic 
of  the  disease  of  the  alveoli  and  of  the  cancelli  of  the  jaw- 
bone ; and  cannot  be  cured  but  by  a practice  which  reaches  to 
the  root  and  origin  of  the  disease. 

OF  THE  FIRST  AND  SECOND  SET  OF  THE  TEETH. 

Before  we  observe  the  classing  of  the  adult  teeth,  we  must 
attend  to  the  two  sets  of  teeth,  the  infantine  or  deciduous  teeth, 
and  the  adult  or  permanent  teeth. 

The  first  set  of  teeth  are  twenty  in  number  : these  are  divid- 
ed into  three  classes  ; the  incisores,  four  in  each  jaw  ; the 


See  Heriffant. 


OF  THE  TEETH. 


241 


cuspidati,  two  in  each  jaw  ; and  the  molares,  four  in  num- 
ber in  each  jaw. 

The  teeth  of  a child  generally  appear  in  this  order : first  the 
central  incisores  of  the  lower  jaw  pierce  the  gum.  In  a month 
after,  perhaps,  their  counterparts  appear  in  the  upper  jaw. 
These,  in  a few  weeks,  are  succeeded  by  the  lateral  incisores 
of  the  lower  jaw  ; then  the  lateral  incisores  of  the  upper  jaw. 
The  growth  of  the  teeth  is  not  after  this  in  a regular  progres- 
sion backwards,  for  now,  instead  of  the  cuspidati,  which  are 
immediately  lateral  to  the  incisores,  the  anterior  molares  of  the 
lower  jaw  slowly  lift  their  white  surface  above  the  gum  about 
the  fourteenth  or  fifteenth  month.  Now  the  cuspidati  pierce 
the  gum  ; and,  lastly,  the  larger  molares  make  their  appear- 
ance, the  teeth  of  the  lower  jaw  preceding  those  above.  The 
last  tooth  does  not  rise  till  the  beginning  of  the  third  year. 

The  teeth  do  not  always  cut  the  gum  in  this  order  ; it  is  only 
the  more  regular  and  common  order.  When  the  teeth  appear 
in  irregular  succession,  more  irritation  and  pain,  and  more  of 
those  symptoms  which  are  usually  attributed  to  teething,  are 
said  to  accompany  them,  an  opinion  which  I believe  to  have 
arisen  from  some  casual  observations. 

The  deciduous  set  of  teeth  terminates  with  the  rising  of  the 
second  molaris  ; for  the  third  molaris  being  formed  about  the 
eighth  year,  when  the  jaw  is  advanced  towards  its  perfect  form, 
is  not  shed,  but  is  truly  the  first  permanent  tooth.  The  molares 
of  the  adult  are  properly  the  permanent  teeth  (immutabiles,) 
for  all  the  others  are  deciduous,  and  are  replaced  by  the  adult 
set ; yet  we  must  recollect  that,  in  opposition  to  Albinus,  in 
this  arrangement,  it  is  more  common  to  speak  of  the  whole  set 
of  the  adult  teeth  as  the  immutabiles. 

In  the  sixth  and  seventh  years  the  jaws  have  so  much  en- 
larged, that  the  first  set  of  teeth  seems  too  small,  spaces  are 
left  betwixt  them,  and  they  begin  to  fall  out,  giving  place  to  the 
adylt  teeth.  But  the  shedding  of  the  teeth  is  by  no  means  re- 
gular in  regard  to  time  ; the  child  is  already  no  longer  in  a 
state  of  nature,  and  a thousand  circumstances  have  secretly  af- 
fected the  health  and  growth.  The  teeth  even  fall  out  three 
years  earlier  in  one  child  than  in  another  : nay,  so  frequently 
are  some  of  them  retained  altogether,  that  it  would  appear  ne- 
cessary to  be  assured  of  the  forward  state  of  the  adult  tooth 
before  the  tooth  of  the  first  set  should  be  thoughtlessly  drawn. 

The  jaw-bones  at  e still  so  small,  that  the  second  set  of  teeth 
must  rise  slowly  and  in  succession,  else  they  would  be  accumu- 
lated into  too  small  a circle,  and  of  course  turned  from  their 
proper  direction. 

' Vol.  IV.  2 H 


‘242 


APPENDIX. 


The  incisores  of  the  under  jaw  are  loose  commonly  when 
the  anterior  of  the  permanent  molares  are  thrusting  up  the  gum. 
The  permanent  central  incisores  soon  after  appear,  and  in  two 
or  three  months  those  of  the  upper  jaw  appear.  In  three  or 
four  months  more  the  lateral  incisores  of  the  lower  jaw  are 
loosened,  and  the  permanent  teeth  appear  at  the  same  time  the 
anterior  molares  have  appeared.  The  lateral  incisores  of  the 
upper  jaw  follow  next;  and,  in  from  six  to  twelve  months 
more,  the  temporary  molares  loosen,  the  long  fangs  of  the  cus- 
piclati  retaining  their  hold  some  time  longer. 

The  anterior  molares  and  the  cuspidati  falling,  are  succeeded 
about  the  ninth  year  by  the  second  bicuspides  and  the  cuspi- 
dati. The  posterior  bicuspides  take  the  place  of  the  posterior 
molares  about  the  tenth  or  eleventh  year.  The  second  perma- 
nent molares  do  not  appear  for  five  or  six  years  from  the  com- 
mencement oi  the  appearance  of  the  permanent  teeth.  The 
last  of  the  molares,  c r the  dens  sapiente,  appears  from  the  fif- 
teenth to  the  twentieth,  or  even  to  the  twenty-fifth  year. 


CLASSES  OF  THE  ADULT  TEETH. 

The  teeth  at  full  maturity  are  thirty-two  in  number,*  and 
they  are  divided  into  these  classes,  incisores , cuspidati , bicus- 
pidi , and  molares. 

The  incisores  are  eight  in  number,  four  in  each  jaw  : they 
are  of  the  simplest  form,  their  edges  are  even,  and  laterally 
they  contract  equally  to  the  neck  : they  are  gibbous,  forward, 
and  slightly  concave  on  the  inside  ; their  roots  are  simple. 
The  incisores  of  the  upper  jaw  are  larger  and  stronger;  those 
of  the  lower  jaw  are  smaller,  neater,  and  for  the  most  part 
evenly  set,  while  the  teeth  of  the  upper  jaw  are  more  fre- 
quently irregular  from  being  crowded  together. 

The  cuspidatif  are  four  in  number,  one  lateral  to  the  in- 
cisores of  each  jaw.  They  are  stronger  than  the  last  in  their 
form  ; thicker  at  their  base  : in  the  gum  more  convex  forward, 
and  terminate  with  a notched  central  point.  In  general,  and 
particularly  in  the  lower  jaw,  they  project  further  than  the  other 
teeth;  their  roots  are  single  and  long  ; they  stand  betwixt  the 
incisores  and  grinders  in  form  as  in  place,  for  they  seOm 
neither  perfectly  adapted  to  cut  like  the  incisores,  nor  tor 
grinding.  “ We  may  trace  in  these  teeth,”  says  Mr.  Hunter 

* From  twenty-eight  to  thirty-two  in  number  — Hunter. 

f Dentes  caiiini , tlie  eye-teeth,  from  their  place  of  original  lodgment  in  the 
upper  jaw. 


OV  THE  TEETH. 


243 


u a similarity  in  shape,  situation,  and  use,  from  1 he  most  im- 
perfect carnivorous  animal  which  we  believe  to  be  the  human 
species,  to  the  most  perfect  carnivorous  animal,  the  lion.” 

Next  in  order  from  the  symphysis  of  the  jaw  rise  the  bi- 
cuspides,  the  fourth  and  fifth  teeth.  These  are  eight  in  num- 
ber, and  accurately  resemble  each  other.  Taking  one,  we 
may  observe  that  it  is  flattened  laterally,  answering  to  the  flat 
side  of  the  root,  and  that  it  terminates  in  two  acute  points  : 
the  internal  of  these  points,  evtn  when  not  worn  down,  is  the 
least.  The  second  bicuspes  is  often  wanting.  The  bicuspides 
are  veiy  often  called  the  anterior  grinders.  Their  roots  are 
single,  or  appear  like  two  fangs  united  ; or  the  first  bicuspes  has 
in  general  two  small  fangs,  or  is  rather  forked  ; the  others 
seldom  more  than  one.  Their  roots  are  oftener  curved  than 
those  of  the  other  teeth. 

The  first  and  second  grinders  are  nearly  alike.  The  body 
of  these  forms  almost  a square  ; generally  five  points  project 
from  their  grinding  surface,  which  makes  an  irregular  cavity 
in  the  centre  : often  some  lesser  tubercles,  or  points,  are  to  be 
observed  at  the  base  of  the  larger  ones.  The  neck  of  the 
tooth  is  but  little  contracted.  There  are  two  fangs,  one  for- 
ward, the  other  backward,  with  their  edges  turned  outward  ; 
their  extremities  are  broad,  often  bifurcated,  and  shorter  than 
those  of  the  bicuspides.  There  are  two  cavities  to  each  fang 
leading  to  the  general  cavity  in  the  body  of  the  tooth.  The 
fangs  at  their  middle  part  are  generally  bent  a little  backward. 
The  upper  grinders  have  three  diverging  fangs,  and  they  are 
more  pointed,  and  have  but  one  canal.  They  are  directly  un- 
der the  floor  of  the  maxillary  sinus. 

The  jaw  acquires  its  full  proportion  about  the  age  of  eigh- 
teen or  twenty,  when  the  third  molaris,  or  the  dens  sapientice , 
makes  its  appearance.  It  is  shorter  and  smaller,  and  is  in- 
clined more  inward  than  the  others.  Its  fangs  are  less  regular 
and  distinct,  being  often  squeezed  together.  From  the  cus- 
pidati  to  the  last  grinder,  the  fangs  are  becoming  much  short- 
er ; and  from  the  first  incisor  to  the  last  grinder,  the  teeth 
stand  less  out  from  the  sockets  and  gums. 


FINIS. 


I 

Bell 


